Author Insights: Cancer Risks of Uterine Procedure Probed

Jason D. Wright, MD, of Columbia University College of Physicians and Surgeons, and colleagues found that 1 in 386 women who undergo morcellation for uterine fibroids have undetected uterine cancer. Morcellation may inadvertently spread cancerous tissue throughout the abdomen. Image: Columbia University

Jason D. Wright, MD, of Columbia University College of Physicians and Surgeons, and colleagues found that 1 in 368 women who undergo morcellation for uterine fibroids have undetected uterine cancer. Morcellation may inadvertently spread cancerous tissue throughout the abdomen. Image: Columbia University

More than 1 in 360 women who undergo a surgical procedure to treat noncancerous growths called fibroids that develop from the muscular tissue of the uterus have underlying cancer that may spread as a result of the surgery, suggests a study published in JAMA today.

A minimally invasive procedure to treat fibroids by removing the uterus, laparoscopic hysterectomy, involves use of electric or power morcellators to cut uterine tissue into pieces small enough to be removed through small incisions. This approach to treating uterine fibroids spares women the need for more invasive surgery, which involves longer recovery times. But there has been increasing concern that this less invasive procedure also may inadvertently spread cancerous tissue throughout the abdomen of women who have undiagnosed uterine cancer. Spreading such cancerous tissue can “upstage” the cancer and may lead to worse outcomes. Recently, a JAMA Viewpoint and JAMA news article outlined the concern and the need to apprise women of the benefits and risks of the procedure.

In April, the US Food and Drug Administration (FDA) warned against using morcellation to treat fibroids because of the potential risks. At the time, the agency estimated that 1 in 350 women who undergo surgical treatment for fibroids have undetected uterine cancer. Today’s study bolstered the FDA’s estimate.

The study examined records for 232 882 women who underwent a minimally invasive hysterectomy, including 36 470 (15.7%) whose surgery involved morcellation. The researchers found 99 cases of uterine cancer among the women who underwent morcellation, suggesting a prevalence of 1 cancer per every 368 women. Older women were at greater risk than those younger than 40 years of having underlying cancer.

Jason D. Wright, MD, chief of the division of gynecologic oncology and associate professor at Columbia University College of Physicians and Surgeons, discussed the findings with news@JAMA.

news@JAMA: Why did you decide to do the study?

Dr Wright: Once the controversy about electric power morcellation for uterine fibroids started to grow, we looked at the available data. We found little data describing the risks of underlying cancer in women undergoing morcellation.

news@JAMA: How do your findings compare with other studies?

Dr Wright: Most of the prior studies were not specific to morcellation. They just looked at cancer rates among those undergoing hysterectomy. Our study looked specifically at patients undergoing morcellation and found that the risk of having an underlying uterine cancer was 1 in 368. It’s fairly consistent with what the FDA estimated.

news@JAMA: What do your findings add to the current debate about the risks of morcellation?

Dr Wright: It’s one of the first large-scale studies looking at power morcellation. It provides a national estimate of the risk of morcellation. It’s important information for patients and clinicians so they can gauge the risks and benefits. We also looked at precancerous changes in the uterus and the risk factors and predictors of cancer. Age was a strong risk factor. If you are older, you are much more likely to have an underlying cancer.

news@JAMA: About a week ago, an FDA advisory panel concluded there is unlikely to be any way to reduce the cancer-associated risks of morcellation. What’s your reaction to that?

Dr Wright: Our study didn’t specifically address the risk of spreading cancer. The question is, if you undergo morcellation, how much does it increase your risk? Does it affect survival? There is not much objective data about techniques to reduce morcellation risk.

news@JAMA: What do you think women and physicians should know?

Dr Wright: The most important finding is that there is definitely a risk associated with underlying cancer or precancerous changes in women undergoing morcellation. It’s hard to detect prior to surgery. Morcellation may allow some women to undergo a minimally invasive surgery. Our study gives patients and physicians an estimate of the cancer risks so they can make an informed decision.



Categories: Gynecology, Oncology, Surgery, Women's Health

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