Ageism in medical students' treatment recommendations: The example of breast-conserving procedures

Purpose. Age bias may play a role in physicians' discussions of equivalent therapeutic options with patients, especially in respect to breast-conserva tion therapy. This study investigated bias based on age (ageism) among phys icians-in-training in their treatment recommendations for breast-conserving procedures. Method. Second-year medical students responded to a questionnaire concernin g recommendations they would make for breast conservation or mastectomies w ith or without breast reconstruction for eight patients with similar-stage breast cancer. The patients differed by age (older were greater than or equ al to 59 years, younger less than or equal to 31 years), race, and marital status. A total of 116 students made 1,146 recommendations. Percentages of the students' recommendations for breast-conservation therapy (BCT) were ca lculated for the two patient age groups and for the recommendations for bre ast reconstruction after the patient had already chosen modified radical ma stectomy (MRM). Chi-square tests were used for statistical analysis. Results. The students recommended BCT for a significantly higher percentage of younger patients than older patients (86% versus 66%; p < .001). They r ecommended MRM to 34% of older patients versus 14% of younger patients (p < .001). Furthermore, the students recommended breast reconstruction after M RM to a significantly higher percentage of younger patients than older pati ents (95% versus 65%; p < .001). Conclusions. Medical students' recommendations of breast conservation and b reast reconstruction showed age bias. Educational efforts should be institu ted during the medical school to decrease ageism in students' treatment rec ommendations.