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Gynecologic oncology includes increasing percentages of women. This study characterizes representation of faculty by gender and subspecialty in academic department leadership roles relevant to the specialty.The American Association of Medical Colleges accredited schools of medicine were identified. Observational data was obtained through institutional websites in 2019.144 accredited medical schools contained a department of obstetrics and gynecology with a chair; 101 a gynecologic oncology division with a director; 98 a clinical cancer center with a director. Women were overrepresented in academic faculty roles compared to the US workforce (66 vs 57%, p 0.01) but underrepresented in all leadership roles (p 0.01). Departments with women chairs were more likely to have50% women faculty (90.2 vs 9.8%, p 0.01); and have larger faculties (80.4 vs 19.6%20 faculty, p = 0.02). The cancer center director gender did not correlate to departmental characteristics. A surgically focused chair was also associated with50% women faculty (85.7 vs 68.3%, p = 0.03); faculty size20 (85.7 vs 61.4%, p 0.01); and a woman gynecologic oncology division director (57.6 vs 29.4%, p 0.01; 68.4 vs 31.7%, p 0.01) and gynecologic oncology fellowship (50 vs 30.4%, p 0.01; 59.1 vs 32%, p 0.01). Gynecologic oncology leadership within cancer centers was below expected when incidence and mortality to leadership ratios were examined (p 0.01, p 0.01).Within academic medical schools, women remain under-represented in obstetrics and gynecology departmental and cancer center leadership. Potential benefits to gynecologic oncology divisions of inclusion women and surgically focused leadership were identified.

ObjectiveWomen make up a majority of the gynecologic oncology workforce. Increasing the numbers of women in leadership has been proposed as a path towards professional gender equity. This study examined whether leadership gender and departmental infrastructure impact the work environment for women gynecologic oncologists.MethodsMembers of a 472-member private Facebook group “Women of Gynecologic Oncology” (WGO) who self-identified as women gynecologic oncologists provided demographics, practice infrastructure, personal experience with workplace bullying, gender discrimination, microaggressions using a REDcap survey platform.ResultsOf 250 (53%) respondents to this survey, most were younger than age 50 years (93.6%); White (82.2%) and non-Hispanic (94.3%); married (84.7%); and parenting (75.2%). Practice environments included academic (n=152, 61.0%), hospital employed (n=57, 22.9%), and private practice (n=31, 12.4%), and 89.9% supervised trainees. A significant percent of respondents had experienced bullying (52.8%), gender discrimination (57%) and microaggressions (83%). Age, race, ethnicity, practice setting, or mentorship were not statistically significantly associated with these experiences. Reported perpetrators were varied and included colleagues (84%), patients (44%), staff (41%), administrators (18%), and trainees (16%). Prevalence of bullying (55.0 vs 47.7%, p=0.33), gender discrimination (59.1 vs 52.3%, p=0.33) and microaggressions (83.3 vs 83.0%, p=1.00) were similar irrespective of departmental leadership gender.ConclusionsWomen gynecologic oncologists report a high prevalence of workplace bullying, gender discrimination and microaggressions regardless of the gender of their immediate leadership. Proactive and deliberate structural interventions to improve the work environment for surgeons who are women are urgently needed.

Objectives: A high prevalence of gender discrimination and harassment has been previously described among gynecologic oncologists. This study examined whether characteristics of leadership and departmental infrastructure impact the work environment for women gynecologic oncologists (GO). Methods: We conducted an internet-based, institutional review board (IRB) exempt survey of female gynecologic oncologists and fellows in training who are members of a 472-member Facebook group named Women of Gynecologic Oncology (WGO). Using REDcap survey platform, members provided their demographics, practice infrastructure, personal experience with workplace bullying, gender discrimination, microaggressions, and outcome effects. Demographic, practice and work environment data were summarized using descriptive statistics. Chi-square tests were used to compare work environments by leadership and departmental infrastructure characteristics. Results: Between 7/20/2020 and 8/19/2020, 250 of 472 (53%) WGO members participated in the study survey. Most respondents were younger than age 50 years (93.6%), White (82.2%) and non-Hispanic (94.3%). A majority were married (84.7%) and had children (75.2%). Practice environments included academic (n=152, 61.0%), private practice (n=31, 12.4%), and hospital employed (n=57, 22.9%), while 89.9% supervised trainees. Most respondents reported within the department of obstetrics and gynecology (n=193, 77.5%); of those who reported elsewhere, 20 (35.7%) reported to a department of surgery. A total of 40% reported to a woman as chair; and 87 (43.3%) had a woman division director. Only 16.1% of respondents reported having a formal faculty mentor, and 55% of mentors were female. A total of 178 (71.8%) of women felt supported by their division; 153 (61.7%) by their department; 106 (76.3%) felt their suggestions are heard. Most respondents had experienced bullying, sexual harassment and microaggressions (Table). Age, race, ethnicity, practice setting, or mentorship were not statistically significantly associated with these experiences. A total of 30 (12%) of respondents perceived gender to negatively impact the careers of their male colleagues. Compared to respondents with a male chair, those with a female chair experienced similar rates of bullying (55.0 vs 47.7%, p=.33); gender discrimination (59.1 vs 52.3%, p=0.33); or microaggressions (83.3 vs 83.0%, p=1.00). Division director gender, specialty or department reporting structure were similarly not statistically significantly associated with the experience of bullying, gender discrimination or microaggressions. Download : Download high-res image (461KB) Download : Download full-size image Conclusions: Women GOs reported high rates of workplace bullying, gender discrimination and microaggressions regardless of the characteristics of their immediate leadership. These experiences begin early in the careers of women. The sources of these behaviors are multiple and varied. Proactive and deliberate intervention to improve the work environment for women GOs are urgently needed.

Gynecologic oncologists have different practice patterns based on practice setting and adjuvant treatments offered. Hospital and practice call coverage is not standardized and can vary widely as well. This study sought to: 1) Document the variety of practice settings and volume 2) Document the variety of support providers and their roles within these practice settings 3) Document vacation and CME time allocated 4) Document call coverage solutions.

11013 Background: A high prevalence of gender discrimination and harassment has been described among gynecologic oncologists (GOs). This study examined the work environment for women GOs and delineated the perpetrators of negative behaviors. Methods: An internet-based, IRB exempt survey of members of a 472-member Facebook group “Women of Gynecologic Oncology (WGO)” was conducted. Using REDcap survey platform, members provided demographics, practice infrastructure, personal experience with workplace bullying, gender discrimination, microaggressions, and outcomes. Demographic, practice and work environments and perpetrators of negative behaviors were summarized using descriptive statistics. Results: Between 7/20 and 8/19/2020, 250 (53%) of active WGO members participated in this survey. Most respondents were younger than 50 years old (93.6%); white (82.2%) and non-Hispanic (94.3%). A majority were married (84.7%) with children (75.2%). Practice environments included academic (152, 61.0%), private practice (31, 12.4%), and hospital employed (57, 22.9%). 89.9% supervised trainees. 130 (52.0%) respondents reported bullying, 140 (56.0%) gender discrimination, and 83% having experienced gender-based microaggressions. Age, race, ethnicity, practice setting, division director or chair gender or department reporting structure were not significantly associated with these experiences. Perpetrators of bullying, gender discrimination, and microaggressions were widely distributed (Table). Of those reporting bullying, 61 (46.6%) reported a male perpetrator, 25 (19.1%) female and 45 (34.4%) an equal gender distribution; of those reporting discrimination 105 (74.5%) reported a male perpetrator, 9 (6.4%) female and 27 (19.1%) an equal gender distribution. 32.9% of survey respondents acknowledged having been written up for speaking up in a way that would have been tolerated from a male colleague. 18.3% of respondents have changed jobs because of bullying; 13.5% because of discrimination. Conclusions: Women GOs report high rates of workplace bullying, gender discrimination, and microaggressions regardless of practice setting that often impact their careers. Perpetrators of these behaviors are multiple and varied. Proactive and deliberate interventions to improve the work environments for women GOs are urgently needed.[Table: see text]

e19056 Background: Within academic medicine, there has been increasing attention to diversity and inclusion. We sought to characterize gynecologic oncologist (GO) faculty inclusion, with attention to gender in relevant academic leadership roles. Methods: Using the American Association of Medical Colleges list of accredited schools of medicine academic institutions were identified. Observational data was obtained through institutional websites in 2019. Results: Of 154 accredited medical schools, 144 contain a department of obstetrics and gynecology (OBG) with a chair; 103 a GO division with a director; 98 a clinical cancer center with a director. GO divisions included an average of 3.1 faculty. 55% of GO faculty were women, compared to 66% of OBG faculty (p < 0.01). 38% of the GO division directors were women which was an under-representation (p < 0.01). GOs made up 10% of OBG faculty and 15.4% of OBG chairs (NS). Women GOs made up 7.9% of women OBG faculty and 8 (5.6%) women GOs were OBG chairs (NS). 9.9% of GO faculty (11.6% of women GO faculty) report to women GOs at the chair level. OBG departments with a GO chair were more likely to have a woman GO division director (68.4 vs 31.7%, p < 0.01), and GO fellowship (59.1 vs 32%, p < 0.01). The majority (59%) of cancer centers directors were medical oncologists (see Table). 2 (2%) of cancer center directors were GOs; 1 at an NCI designated cancer center. Neither GO directors were women. Incidence to leadership and mortality to leadership ratios were calculated compared to expected rates by SEER 2019. By these measures GOs were underrepresented in cancer center leadership (p < 0.01, p < 0.01). Conclusions: Despite representative leadership of GO and women GO within in OBG leadership, most GOs report to non-oncologists at the department chair level. Potential benefits of GO leadership within OBG departments were identified. The practice of gynecologic oncology includes complex medical and surgical cancer care making these physicians uniquely qualified for cancer center, but representation of GOs in cancer center leadership is low and women GO were absent from cancer center director positions. Without inclusion of GO in cancer center leadership, existing inequities in clinical care, research and funding for gynecologic malignancies may be amplified. [Table: see text]

A 38-year-old woman with metastatic malignant struma ovarii, including massive liver metastases and retroperitoneal lymphadenopathy, underwent ovarian resection and retroperitoneal lymph nodes excision, partial hepatectomy, and radiofrequency ablation for liver metastases. She underwent thyroidectomy and received three I treatments using recombinant human thyrotropin stimulation and radioiodine dosimetry. posttherapy I imaging, anatomic images, and thyroglobulin levels showed significant diminution in the tumor burdens and remarkable decline in thyroglobulin levels. This case provided valuable information on recombinant human thyrotropin-assisted I ablation in conjunction with dosimetry in an unusual presentation of iodine-avid malignant struma ovarii with bulky metastases.

Objective The goal of this study was to characterize presenting symptoms, prognostic factors, and treatment outcome in patients diagnosed with primary gastrointestinal (GI) cancers initially presumed to be of gynecologic origin. Methods A retrospective review of all admissions to the gynecologic oncology service at Saint Luke's Hospital in Kansas City, Missouri, was performed between 1993 and 2003. Twenty-six patients with primary GI cancers who presented with presumed gynecologic malignancies were identified. Clinical and pathologic features were reviewed, methods of diagnosis were recorded, and survival was analyzed by the Kaplan–Meier method. Results One percent of all gynecologic cancer referrals had a tumor of nongynecologic gastrointestinal origin. Seven subtypes of GI cancers were identified, most at stage 4 disease. Colon cancer was identified most commonly (26.9%). Abdominal pain was the most frequent symptom (57.6%), and an adnexal mass was diagnosed in the majority of patients (65.4%). Preoperative endoscopic evaluation provided a definitive diagnosis in only 3.8%. The median survival was 15 months with a 5-year survival of 35%. Ninety-six percent of patients had their GI tumor definitively diagnosed by exploratory laparotomy. Optimal cytoreduction provided a 7-month survival advantage. Conclusion Most patients required a major surgical procedure to establish the primary diagnosis of gastrointestinal cancer. The cancers encountered were almost always at advanced stage disease and were referred to the gynecologic oncologist due to the presence of an adnexal mass and a failed preoperative work-up. Surgical management should include removal of the primary or recurrent GI tumor and cytoreduction of all bulky disease, including adnexal metastases.

A vaccine to prevent infection by human papillomavirus is available in the US. This article reviews the biology of human papillomavirus that allows for the development of both therapeutic and prophylactic vaccines. Issues that may delay the acceptance of the vaccine are discussed.

This study aimed to report the computer-enhanced robotic surgery experience of the authors' gynecologic oncology division.From January 2001 to August 2006, 41 patients underwent laparoscopic surgery by our gynecologic oncology service using a computer-enhanced surgical robot. This report describes a retrospective review of these patients.The patients ranged in age from 27 to 77 years (mean, 44.2 years), in weight from 44 to 131 kg (mean, 72.1 kg), in operative time from 1 h and 50 min to 9 h (mean, 5 h and 2 min), and in estimated blood loss from 50 to 1,500 ml (mean, 253 ml). Of the 20 patients with gynecologic malignancies, 14 had cervical cancer. A total of 21 patients had benign indications for surgery. Complications included shoulder palsy, robot failure, colotomy, bradycardia, and intraabdominal bleeding requiring minilaparotomy and ligation of a bleeding pedicle.This case series is one of the first to report the use of a computer-enhanced surgical robot in gynecologic oncology. This approach proved to be feasible and well tolerated in this series of patients and deserves further study for clarification of its indications, benefits, and safety.

Background A primary mature cystic ovarian teratoma was diagnosed in an adolescent female. She was followed up after initial exploration with computed tomography, pelvic ultrasonography, and serum tumor markers. Recurrent tumor, consisting solely of mature teratomatous elements, was confirmed with 2 subsequent laparotomies. Case This is a report of the growing teratoma syndrome in a young woman with a primary diagnosis of a mature cystic ovarian teratoma not treated with adjuvant chemotherapy. Conclusion The growing teratoma syndrome is an uncommon condition. Surgical resection of recurrent lesions is necessary to reduce potential complications of abdominopelvic organ compression and obstruction and to evaluate for the presence of malignant degeneration.