Gender Representation in American Society for Radiation Oncology Guidelines

Abstract

The American Society for Radiation Oncology (ASTRO) clinical practice guidelines are a consensus generated from the fields' experts and are an established resource in determining the standard(s) of care for disease sites. Representation of female experts on radiation oncology clinical guidelines is unknown. As women are underrepresented in the radiation oncology workforce, we hypothesize that female experts are underrepresented in authorship of clinical guidelines for radiation oncology.Publicly available information of authors on ASTRO guidelines and consensus paper, including gender, degree, medical specialty, academic rank, years in training (at time of guideline or consensus publication), order of authorship, and institution was collected. Statistical analysis was performed using chi-square and odds ratio tests to test for association.Thirty-four ASTRO guideline and consensus documents, including clinical practice guidelines (65%), consensus guidance (15%), and white papers (21%), were reviewed. Of 449 non-unique authors identified, the most commonly represented specialties were radiation oncology (59%), surgery (11%), physics (9%), medical oncology (5%), and cardiology (5%). Among all authors, 33% were female. No association between female gender and specialization in radiation oncology was found (P = 0.5). Of 70 total first and last authors, 32% and 33% were female, respectively. When considering academic rank, male authors were more likely to hold full professorship compared to female authors (51% vs 17%, P = 0.001). Male authors were more likely to have 20+ years of training at guideline publication compared to female authors (34% vs 11%, P = 0.009).Women comprise 1/3rd of expert panelists who author the ASTRO clinical practice guidelines and consensus documents which is similar to the gender breakdown of the radiation oncology workforce. Male authors were more likely to hold full professor rank and have 20+ years of training. As more women enter the radiation oncology workforce, continued conscientious efforts to promote females as senior leaders and academic rank and leadership will be important especially in guideline papers.