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SAN DIEGO -- As gynecologic oncology faces an existential "identity crisis," an analysis projected that new cancer patient loads per physician would fall over the next two decades.

If current trainee numbers remained stable, annual new cancer cases per gynecologic oncologist would fall from 73 in 2025 to 51 in 2045, a decrease of 30%, reported Teresa Boitano, MD, of the University of Alabama at Birmingham, during the Society of Gynecologic Oncology (SGO) annual meeting.

If one clinical fellow was added per year nationally, annual new cases would fall from 73 in 2025 to 47 in 2045, a decrease of 36%.

"This means on average, a gynecologic oncologist will see one patient a week with a [new] cancer diagnosis," Boitano said

Boitano's team also predicted that if trainee numbers stayed stable, surgical cases would increase from 208 to 226 per fellow per year (+9%), but they would fall from 208 to 181 (-13%) if trainee numbers rise.

The findings raise questions about whether gynecologic oncology fellowships should be limited, she said, and "we need to figure out a solution."

Gynecologic oncology is a small subspecialty with , almost all (98.3%) in urban areas. While "oncology" is in the field's name, physicians noted during the presentation that the society's members are increasingly performing benign procedures instead of leaving them to gynecologic surgeons.

This trend has created an "identity crisis" in the field, said SGO discussant Ronald D. Alvarez, MD, MBA, of Vanderbilt University Medical Center in Nashville, Tennessee. "This really begs the question that needs to be asked: Who are we? ... Do we need to change the name of this society? And do we need to change our training requirements?"

At the same time, research has suggested that gynecologic oncology fellowship graduates increasingly lack confidence in their ability to perform routine procedures. Boitano highlighted that found that only 75% of 124 graduates felt comfortable performing radical hysterectomies, compared with 100% per . Rates for ostomy formation were 84% versus 97%, respectively, and 70% versus 88% for inguinal femoral lymph node dissection.

"In order to train fellows adequately, we know that we need to have the right amount of patients to ensure competency," Boitano said. However, "cervical cancer should continue to decrease as HPV vaccine uptake increases. And we're also performing less radical surgeries given the increasing levels of neoadjuvant chemotherapy."

For the current study, Boitano and colleagues used data from the U.S. Census Bureau to make age-specific projections for women through 2045, and age-specific incidence for uterine, ovarian, cervical, vulvar, and vaginal cancers from 2010-2019 based on U.S. Cancer Statistics.

They projected that the total number of annual uterine, ovarian, cervical, vulvar, and vaginal cancer cases will grow from 100,000 in 2019 to more than 120,000 by 2045. New uterine cancer cases are projected to increase by 14%, with minimal changes for other cancers.

Boitano noted that the study findings may represent a "best-case scenario," and the actual decline in patient load could be larger.

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