The following story was written By Shari Rudavsky, a reporter for the Indianapolis Star:
If you're having breast cancer surgery at the Indiana University Simon Cancer Center, odds are your surgeon will be a woman -- under 40. The bulk of breast cancer surgeries at IU Health's Downtown hospitals are now performed by three young female breast surgeons. Drs. Monet Bowling, Kandice Ludwig and Erika Rager are still somewhat of an anomaly -- surgery continues to be a male-dominated field -- but they also reflect a growing shift in women's health care that seems likely to increase.
"Most women, now, when they need to be treated by a breast cancer surgeon, they seek out women," Bowling said, "in the same way that women seek out women obstetrician-gynecologists."
And the search for many patients will become easier in the future.
From 2000 to 2005, the number of women entering general surgery training programs increased by a quarter (from 32 percent to 40 percent), according to a March article in the Journal of the American College of Surgeons.
Many of the people entering breast surgery programs today are women, Ludwig said. Those attending national meetings are still mostly male, but the pendulum is starting to swing.
On Saturday, Bowling and Ludwig will participate in the Susan G. Komen Race for the Cure, joining thousands of survivors, friends and family in a 5K run/walk to raise money for breast cancer education, research, screening and support.
Among those will be Nicole Proctor, 35, participating for the first time as a survivor. Proctor is among those who have realized the special benefits of having a female breast surgeon -- even if she wasn't looking for one. Proctor's beloved family doctor is a man, and he referred her to IU about nine months ago after she found a lump in her breast. Her oncologist is also a man.
Still, Proctor connected immediately with Rager, whom she calls by her first name.
"She was one of the first people (whom) I had a meeting with after my diagnosis who sat me down and said, 'This is what you have, this is what it is, this is what it means,' " Proctor said. "She knew what I needed to hear. She was able to laugh when I needed to laugh."
Recognizing that Proctor has two children under the age of 3 to care for, Rager coordinated her schedule and that of other surgeons so Proctor could have three surgeries on one day in January.
None of the women doctors would suggest men can't take care of breast cancer. It's just that a woman brings a different perspective.
"I think patients really kind of appreciate having the woman's touch," Ludwig said. "Even though we have not been through (breast cancer) personally, I think women patients feel that we may empathize a little better than a man can."
Recently, Bowling said, she's been seeing more young women under 35 with breast cancer. Because she and her colleagues are close to their age, they consider factors such as future fertility when discussing treatment options.
And being women, Bowling added, may help the surgeons empathize with a woman facing the loss of her breasts or a changing body.
"I understand what people are going through," she said, "and the attachment that they might have to their body or their image of their body."
Still, men do have a place in the field, the women agree. Bowling credits Dr. Robert Goulet, one of the city's premier breast cancer surgeons who left IU for Community Health Network a few months ago, with teaching her much about the care of breast cancer patients.
3 doctors, 3 stories
Each woman followed her own path to the operating room.
Bowling knew from when she was about 4, sitting in the kitchen picking apart a raw chicken, that a career in the biological sciences awaited.
"I would dig the veins out of the chicken and peel off the muscle," she said. "I did eat the chicken after it got cooked. But I had to pull all the veins out of it first."
After a brief flirtation with dentistry -- her father was a dentist -- Bowling completed a master's in medical science at Indiana University and continued on to medical school.
Given her early predilections, surgery seemed a natural fit.
At first she considered plastic surgery, but during her residency, she learned she enjoyed talking to patients and families about breast cancer. The only woman in her residency class, Bowling had a knack for these most difficult of conversations.
Medicine was not Rager's initial choice. A chemistry major and South Bend native, she thought she might work for Eli Lilly and Co. Then during college, she participated in a summer program, where she followed a neonatal specialist.
From the first cuts in anatomy class, Rager gravitated toward surgery, but she also was wary.
"Surgery can be kind of a tough lifestyle, so I tried really hard to find something else I would like more," she said. "I just didn't find anything else I liked more."
After completing her residency, Rager earned a master's in public health, focusing her research on women at high risk for developing breast cancer.
Entering the field of breast cancer surgery let Rager link her interests.
"I always knew that I really liked taking care of breast cancer patients, partly because they tend to be just the nicest ladies in the world," she said. "And because it's a very interesting disease and a disease where if people get the appropriate treatment at the appropriate time, it makes a big difference."
During her general surgery residency, Ludwig, like many others in training, performed a substantial number of breast cancer surgeries, because of the disease's prevalence.
She was the only woman in her residency class of four and the seventh in the 25-year-old program. Only one of the 30 or so surgeons at the Texas hospital where she trained was female.
At first, others tried to dissuade her from breast surgery.
"They always told me, 'You're going to have a lot of female patients just because you're a woman. Is this something you're sure you want to do?' " she said. "When I kept saying that's what I wanted to do, they kept saying, 'Are you sure?' "
Finally, she entered a breast cancer fellowship at the University of Michigan, where she discovered colleagues who did not question her.
But none of these three is the first woman to pick up a scalpel at IU. Dr. Susan Clare, who now devotes much of her time to research and her role as co-principal investigator of the Susan G. Komen for the Cure Tissue Bank at the IU Simon Cancer Center, also performs surgeries on breast cancer patients.
Clare, 56, started her surgical residency before these women started college. Still, she was surrounded by women in her training at Northwestern University. But even she had doubts about focusing on the breast, although she knew she was interested in cancer.
Her hesitancy to enter the breast cancer field may have stemmed from hearing a famous woman surgeon say that she did not specialize in breast cancer because it was what others expected of her as a woman.
Then Clare met Dr. Monica Morrow, a strong woman surgeon who specialized in breast cancer, and that fear vanished.
"She could have done anything, but she chose to do breast," Clare said. "That was a powerful statement. . . . She thought this was a really important challenge, that women needed women to take care of them and to embrace this field."
For the three younger women, having female colleagues around their own age is a plus. They try to meet at least once a month on a more casual basis -- over dessert or a glass of wine.
Because they're all in similar places in their lives -- trying to forge a balance between family and career -- that may make them more understanding than a male colleague if one of them becomes pregnant, they agree.
For now, Bowling is the only one of the group who has children, twin toddler boys. Come Saturday, the whole family -- the boys in strollers -- will participate in the race, which is a powerful and poignant reminder of the significance of the career path she's chosen.
Nothing, she said, matches the sensation of walking up the New York Street bridge over the White River and seeing the thousands of walkers behind.
"It's breathtaking," she said. "You see all of the people who care, and you know the importance of taking care of people with breast cancer."