HMN 2025: How Surgeons are at higher risk of cancer

Harvard Medical School investigators have discovered that U.S. surgeons have a cancer mortality rate more than two times that of nonsurgeon physicians and around 20% higher than most non-physician workers. While still maintaining overall lower than non-physician death rates, the unexpectedly high cancer rates might shed light on work-related risks.

In the study, “Mortality Among Surgeons in the United States,” published in JAMA Surgery, researchers analyzed available population-based data to evaluate the rates and leading causes of death among surgeons.

Investigators assessed death records for 1,080,298 individuals aged 25–74 years pulled from the 2023 National Vital Statistics System, including 224 surgeons and 2,740 other physicians.

Death certificate records provided age, sex, underlying cause of death, and usual occupation. Population denominators were drawn from the 2023 American Community Survey and cross-verified with the AMA Physician Masterfile.

Comparison groups included nonsurgeon physicians, other professionals (lawyers, engineers, scientists), and all other workers. Investigators computed mortality per 100,000 population using age and sex standardization to the 2000 U.S. standard population and calculated mortality rate ratios (MRR).

Surgeons recorded 355.3 deaths per 100k compared with 228.4 per 100k among nonsurgeon physicians, yielding an MRR of 1.56. Mortality among surgeons remained far below rates for all other workers (632.5 per 100k) and resembled that of lawyers, engineers, and scientists, which measured at 404.5 (0.88 MRR).

Nonsurgeon physicians were the least likely to die in a car accident at 3.4 per 100k. Surgeons experienced a much higher rate at 13.4 per 100k, making it the 4th-ranked cause of death for the group, while it ranked 9th among all other groups.

This higher ranking does not indicate that surgeons are more accident-prone behind the wheel. In fact, they have fewer deaths per 100k in this category than all the other workers’ groups (13.4 vs. 16.6). Rather, it reflects a rearrangement of rankings due to diminished rates of death from causes more common in other groups.

For example, all other workers’ 4th ranking cause of death is respiratory diseases with 27 per 100k, while for surgeons it ranks 14th at 0.6 per 100k, making them the least at-risk group. Other physicians were at three times the surgeon rate, at 1.8 per 110k.

Surgeons were also the least likely group to die from influenza, kidney disease, liver disease, septicemia, and diabetes. Diabetes death rates were remarkably low in surgeons at 1.6 per 100k (ranked 11th by cause), versus all other workers at 23.8 (ranked 5th) and other physicians at 6.9 (ranked 6th).

A large outlier shows up when comparing death by cancer. Cancer mortality (neoplasm-specific) in surgeons registered 193.2 per 100k compared with 87.5 in nonsurgeon physicians, corresponding to an MRR of 2.21. Cancer is the only category in which surgeons showed a higher rate than all other workers (162.0 per 100k).

The authors suggest that health knowledge and resources across surgical and nonsurgical physicians are similar. Removing the excess 105.7 cancer deaths per 100k would place surgeons and other physicians on near-level mortality rates, prompting concern that surgery-specific workplace factors may be driving the excess cancer deaths.

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