By Yun Rose Li, MD, PhD, Parul Barry, MD, and Adrianna Masters, MD, PhD
While many women scientists and physicians made critical contributions that paved the path to modern day advances in radiation oncology, few were recognized for their work. Perhaps one of the most well-known pioneers in the field of radiation oncology is a woman: Marie Curie, recipient of two Nobel Prizes for her extensive work on radioactivity and the discovery of radium.
But aside from Marie Curie, most of her contemporaries received little acknowledgment. For example, Lise Meitner, an Austrian-Swedish physicist, helped discover the element protactinium-231 and described the process of nuclear fission (Sime, 1996). Her work demonstrating that uranium atoms split when bombarded with neutrons allowed for the later development of nuclear energy and nuclear bombs. For her contributions, she was nominated for the Nobel Prize in chemistry and physics 48 times, though she never received the award.
Another example is Margaret Cleaves, who in the early 1900s was one of an estimated 20 physicians (the only female) to have access to radium for clinical purposes and ultimately became the first to use radium in gynecology to treat cervical cancer (Aronowitz, Aronowitz, & Robison, 2007). She was heavily criticized and was largely dismissed by other physician colleagues. At that time, not only were educational opportunities and access to postgraduate training for women extremely limited, but society placed strict limitations on the role of women as physicians and leaders in medicine.
It was not until the demands created by WWI and WWII that broader access to medical/graduate education and career opportunities, aside from those that were traditionally seen as “feminine” roles, were made available to women. Often considered to be a founder of nuclear medicine, Edith Quimby studied the medical effects of radiation and dose limiting side effects with the application of radioactive isotopes in the treatment of thyroid disease, brain tumors and other cancers during her time at Memorial Hospital for Cancer and Allied Disease in New York (Linton, 2012). In 1954, she became the first female president of the American Radium Society and was the recipient of the Janeway Medal of the American Radium Society, the Gold Medal of the Radiological Society of North America and the Gold Medal from the American College of Radiology.
Other important women who made contributions to radiation oncology include Chien-Shiung Wu, also known as the First Lady of Physics. Wu, a Chinese American particle and experimental physicist, worked on the Manhattan Project and played an important role in the advancement of nuclear and particle physics. Despite their successes, very few women obtained faculty positions and even fewer chaired departments during the mid-1900s. One example was Ruth Guttman, who became the director of the Department of Radiotherapy at Columbia University from 1955 to 1976. Other notable examples include Florence Chu, who was the chair of Radiotherapy at Memorial hospital 1976-1984, and Anna Hamann, who at the end of a long career, became the director of radiation therapy at Evanston Hospital, although she never attained a full professorship. These women and many other women physicians and scientists overcame tremendous challenges and faced persecution and hostility in order to pursue their dreams to advance the field of radiation oncology and radiation physics.
Though many would like to believe that efforts made to address challenges faced by women in science and medicine have allowed women to break the glass ceiling in radiation oncology, there is still a lot left to do. In fact, the lack of gender diversity among radiation oncologists begins with medical school applicants and continues to widen throughout career development. Currently, women represent at least half of all medical school students but make up only 30% of applicants to radiation oncology training programs. The gender disparity widens as women progress in their careers, with leadership positions and chair positions further widening the gap: academic positions 17.4% and female chairs 11.7% (Gharzai and Jagsi 2020).
Leadership roles on editorial boards of oncology journals are another area of noticeable disparities in representation of underrepresented minorities and women. A recent abstract presented by Patel et al. reviewed 54 oncology journals and 793 board members, and there was not a single editor-in-chief position held by a minority female. At a time when COVID-19 has disproportionately affected the career development of women, who often serve as primary caretakers at home, how do we create an even ground for achieving career success? This is a pivotal time to reevaluate our measures of productivity and the metrics we use to decide on tenure or promotion. Recognizing that women in STEM in general have shown much larger interruptions in submissions to journals during this time than their male counterparts, even those with young children, the charge is with institutions and national organizations within our field to make a change to do better for women in radiation oncology.
We would argue that we need to promote diversity of not just representation and service on committees, but chairing committees, successfully applying for FASTRO status and even the Gold medalists. We reviewed the listed ASTRO Gold medalists on the website and found that since 1977 only 12% of honorees were female. The majority of the current ASTRO executive committee is female. In reviewing the chair and vice-chair positions of the councils, two of five council vice-chairs are women. Because portions of the application process for FASTRO focus on recommendations of existing recipients, leadership roles and other metrics of academic success, is this placing an undue burden on persons from underrepresented groups? We are curious to know what the success rates are for applications and if there is a way to blind applications to reduce bias.
It is important to recognize that, even though much remains to be done to level the playing ground for women in radiation oncology, our field has seen enormous contributions made by women, and more and more women are being recognized for their work. The 2021 ASTRO Gold medalists were notably both women (Colleen Lawton, MD, FASTRO, and Lori Pierce, MD, FASTRO). Moreover, Sue Yom, MD, PhD, FASTRO, who has made tremendous contributions to major societies in our field including ASTRO and American Radium Society where she is the immediate past chair, is the incoming editor-in-chief of the Red Journal.
What are some of our thoughts on increasing representation of diverse groups of people in leadership?
- Recognize the accomplishments of others and go out of your way to highlight those who may not be in a position to do it for themselves.
- Do not assume that someone doesn’t want to serve in a leadership role, is too busy or wouldn’t want to take time away from a specific activity (raising young children, for example). Why not simply ask?
- Offer support in a positive way that sponsors the success of others and specifically think about multiple candidates for a task or role in leadership.
- Be thoughtful with your word choices and their impact on those around you.
- Acknowledge the additional burden of unpaid domestic work, specifically during global pandemics, and think about ways to provide resources: Adapt to a changing environment to allow diversity of experience to enrich our culture as radiation oncologists!
- Be aware of biases, speak up when you recognize them and acknowledge when you recognize your own. Positive change cannot happen unless we do.
Join us on the ROhub to share your thoughts and discuss: What other ways can we support diversity of leadership and diversity of thought?
And be sure to acknowledge Marie Curie on Sunday, November 7 with #WeWhoCurie day!
Aronowitz JN, Aronowitz SV, Robison RF. Classics in brachytherapy; 2007.
Gharzai LA, Jagsi R. Ongoing Gender Inequity in Leadership Positions of Academic Oncology Programs: The Broken Pipeline. JAMA Network Open 3 (3): e200691–e200691. 2020. doi:10.1001/jamanetworkopen.2020.0691
Linton O. Edith H. Quimby. Journal of the American College of Radiology, 9(6), 449. 2012. https://doi.org/10.1016/j.jacr.2011.11.020
Sime RL. Lise Meitner: A Life in Physics. University of California Press. 1996.
By Raymond Mailhot Vega, MD, MPH
In mid-December, a colleague emailed me a link to an ROhub discussion on the creation of a society for Hispanics in radiation oncology. This prospect excited me. Representation matters. As a Latino becoming a radiation oncologist, I did not see myself in the workforce. Becoming what I did not see presented unique challenges and, at times, a feeling of isolation since I struggled to find others who had shared my experiences. A silver lining is charting your own territory, but being on your own, it can be hard to know if you’re making progress heading towards your destination. How do you explain to an attending whose feedback post-consult is, “Wow, you speak Spanish so well” that while meant as a compliment, so do 15% of Americans and such an observation does not provide a meaningful critique of my patient knowledge or my memorization of the inclusion criteria of PORTEC-2. Now as an attending and full member of ASTRO, I am eager to extend a hand to the next generation as they navigate their careers.
Recently, ASTRO has been working to create different ROhub communities to provide virtual spaces for communities of radiation oncologists to gather, addressing an important need. A space for communities of radiation oncologists to gather is manifold in its benefits. Latinx physicians are drastically underrepresented in radiation oncology at only 2% of the rad-onc workforce overall,1 despite the fact that 15% of Americans identify as Hispanic. Established in education is the credo “you can’t be what you can’t see,” and medical training and employment is no different. A virtual affinity space allows for mentorship of trainees and junior faculty seeking career advice. A dedicated space also provides mental health support. Physician burnout continues to gain more visibility, and the extra stress and invisible labor that more commonly burden diverse faculty are well-documented.2 A defined space for Latinx doctors facilitates the creation of a community in which we can share our common experiences, interests, stories and struggles.
Some may feel that purposely creating communities around race or ethnicity could increase divisions between people. Divisions already exist, and the “I don’t see race” perspective from the 1990s blinds ourselves and hinders our ability to dismantle the extraordinary barriers developed over hundreds of years of systemic racism that affects both patients and doctors. A dedicated community can provide a safe space to generate ideas from lived experience and foster leaders to represent that community among the larger membership. The COVID-19 pandemic has thrust in the spotlight the disparities that communities of color have faced, and a forum representing those affected can create opportunities that successfully address such inequities in health care and oncology.
To address the need for connection among physicians, physicists and trainees, ASTRO is launching various ROhub communities. These forums will create a virtual space in which ASTRO’s underrepresented and diverse members can congregate and network along with all members who wish to participate. I am excited for ASTRO’s debut and kick-off of these ROhub communities — intentional spaces for radiation oncologists to unite and grow from shared experiences. Particularly as we face social changes with our Annual Meeting moving to a virtual experience, planned socializing and networking must adapt. The timing for this initiative could not be more appropriate. Opportunity is not a zero-sum game: we don’t have to lose power or influence when others gain it. Increased diversity will push our research forward, bring new ideas to the forefront and result in higher-quality care for all patients.
ASTRO’s initiative will provide a broader tent for all of us. I encourage you to speak out for increased equity in representation of your brown and Black radiation oncology colleagues, for bridging the health-care disparities that patients of color face, for making our system more accessible for the disabled, for improving gender parity among our workforce and for creating a safe space for those who identify as LGBT+. Our time is now.
Since the submission of this blog post, ASTRO is pleased to announce the launch of the Gender Equity Community on the ROhub, a space for members to discuss gender gaps, offer mentorship and seek or provide helpful resources. The community was created for those personally encountering gender-related concerns and for those who wish to support and promote gender equity within their workplace. Work is underway to launch additional communities in the coming months.
Raymond Mailhot Vega, MD, MPH, is a gay, Latino assistant professor at the University of Florida, where he directs the hematology radiotherapy program in addition to treating pediatric patients and patients with breast cancer. He is a recipient of a Global Oncology-Young Investigator Award to conduct educational interventions for pediatric radiotherapy treatment in Mexico to reduce disparate outcomes.
1. Fung CY, Chen E, Vapiwala N, et al. The American Society for Radiation Oncology 2017 Radiation Oncologist Workforce Study. Int J Radiat Oncol Biol Phys. 2019; 103: 547-56.
2. Matthew PA. What is Faculty Diversity Worth to a University? The Atlantic. 2016 November 23, 2016;Sect. https://www.theatlantic.com/education/archive/2016/11/what-is-faculty-diversity-worth-to-a-university/508334/. Accessed on May 11, 2020.