Health Equity: Women and Underrepresentation in Urologic Oncology

At the American Urological Association (AUA) 2022 meeting in New Orleans, Eila C. Skinner, MD, of Stanford Health Care, chaired the presentation on women in urologic oncology. The presentation was divided into segments with Cheryl T. Lee, MD, of Ohio State Medical Center, providing an overview of the history of women in the field. Sarah Psutka, MD, MSc, of the University of Washington, spoke on the history of the organization Women in Urologic Oncology (WUO), a section of the Society of Urologic Oncology (SUO). Kristen Scarpato, MD, MPH, of Vanderbilt University Medical Center, discussed the process of creating a pipeline for the production of urologic oncologists. Finally, Sima Porten, MD, MPH, of University of California San Francisco, explained the importance of supporting women healthcare professionals in urologic oncology, as well as promoting underrepresented minorities in achieving careers in the field.

Women in Urologic Oncology

Dr Lee began her presentation by outlining the history of the founding of SUO, where in May 1984, the founders sought to create an identity for AUA members that focused on urologic oncology. They sought to bring urologic oncology “to the table” by gaining representation in important government organizations, such as at the National Cancer Institute, and pushing the field forward by obtaining funding for clinical trials. Dr Lee identified parallels in the founding of the WUO, which tailored its focus to the needs of women urologic oncologists and female urologic oncology patients. She highlighted the contributions of several trailblazers, including Dr Elisabeth Pickett, the first female urologic oncologist trained by the late Dr Willet Whitmore, former chief of urology at Memorial Sloan Kettering Cancer Center.

Dr Lee also explained why adequate female representation in the SUO and WUO is important for patient care. She cited an article by Siegel et al,1 which estimates a total of ~445,000 patients with genitourinary cancer in the United States of whom approximately 11% (~49,700) are female. Therefore, Dr Lee recommended that at least 11% of the active SUO membership should be female, to ensure fair representation and patient care.  Citing additional data from a report by Wallis et al,2 she noted that when female urologic oncologists treated patients with radical cystectomy, there was a slightly lower rate of complications and hospital readmissions compared with their male counterparts, although this finding was not statistically significant.

Creating a Diverse Community

Next, Dr Psutka discussed the process for creating a diverse and equitable community in urologic oncology. She began by citing data demonstrating that, although more than 50% of current medical students are women, fewer than 10% of female urology residents ultimately apply for fellowship training. She noted that fewer than 3% of female urologists hold full professorships in urology compared with 12% of their male counterparts. Then she began to speak briefly about the history of the WUO, which went from informal meetings of the female urologic oncologists in 2015 to formal application for recognition in 2019.

According to Dr Psutka, the process of forming such affinity groups results in networking opportunities for professionals from underrepresented populations and ultimately leads to the equity that creates value. She reviewed the goals of the WUO, including providing representation to female members through mentorship and advocacy, and promoting recruitment and retention of its members. To highlight her point, she presented data showing that since the creation of the WUO, SUO membership has risen steadily from 78 members in 2021 to 91 members in 2022. Furthermore, more female physicians are attending the SUO annual meeting and have joined in leadership positions at the SUO.

Succeeding Dr Psutka, Dr Scarpato talked about addressing the training pipeline for women in urologic oncology. Citing a study by Nettey et al,3 Dr Scarpato explained that, compared with their male counterparts, very small numbers of women enter the urologic oncology subspecialty; however she noted that the high numbers of women who choose to specialize in female pelvic reconstruction and pediatric urology suggest more work could be done to encourage interest. She cited additional statistics, such as that while roughly 11% of practicing urologists are female, only 4% of them focus on oncology. In regard to those in training, Dr Scarpato explained that between 2011 and 2017, the number of women applying to SUO-accredited oncology fellowships was in the single digits, although it has slowly started to rise, with 17 applicants in 2021.

To underscore her point, she cited data obtained from the AUA 2020 urology match survey showing that female and underrepresented minority (URM) applicants were more likely to rank a program highly if female or URM faculty were present in the leadership. Dr Scarpato gave the audience tips for promoting female and URM involvement in urology, including encouraging awareness of the issue though discussion, offering mentorship, diversifying the workforce, and promoting a supportive work environment by offering policies such as parental leave and pay equality.

The Future of Diversity in Urologic Oncology

At the end of the plenary session, Dr Porten discussed the future of women and URMs in urologic oncology. She spoke first about finding success, distilling the process down to several key steps, including finding a passion within urologic oncology and then building a network of mentors to help guide the candidate through their career. She emphasized the importance of meeting new colleagues and taking risks throughout one’s career.

How can one support their female or URM colleagues? She advised all individuals to recognize and unlearn prior biases and to advocate for their peers. She also noted the critical role of sponsorship. Distinct from mentors, sponsors are individuals who have only intermittent transactional relationships with a candidate but can significantly promote their career advancement. She commented that mentors can also serve as sponsors if they have access to resources the candidate would require for career advancement.

She emphasized that mentorship is itself a critical component of the career advancement process. Specifically, a good mentor will share his or her own career trajectory, and provide the candidate with guidance, motivation, and emotional support. Specific examples of mentor functions include reviewing grants, reviewing papers, and providing feedback. She emphasized that a good mentor-mentee relationship is reciprocal, and that most good relationships will be ones where the pair share mutual goals and needs. Together, the strategies shared by the panelists to help promote greater diversity in the urologic oncology workforce were well-received by a wide audience of AUA attendees.

Akhil Abraham Saji, MD is a urology resident at New York Medical College / Westchester Medical Center. His interests include urology education and machine learning applications in urologic care. He is a founding and current member of the EMPIRE Urology New York AUA section team.

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. doi: 3322/caac.21708
  2. Wallis CJD, Jerath A, Kaneshwaran K, et al. Association between surgeon and anesthesiologist sex discordance and postoperative outcomes: a population-based cohort study. [Online ahead of print.] Ann Surg. doi: 10.1097/SLA.0000000000005495
  3. Nettey OS, Fuchs JS, Kielb SJ, Schaeffer EM. Gender representation in urologic subspecialties. 2018;114:66-70. doi: 10.1016/j.urology.2017.12.034