Tuesday, September 6, 2022 (HealthDay News) – Surgery for Uterine fibroids It can often be performed with minimally invasive techniques that avoid a hospital stay. A recent study found that black and Hispanic women may be less likely to receive these treatments.
Uterine fibroids are noncancerous growths in the uterus. Sometimes they don’t cause any problems, but when they do occur — such as heavy monthly bleeding and pain — treatment may be necessary.
One option is surgery: a myomectomy, which removes only the fibroids. or a Hysterectomywhich removes the uterus. The surgery can often be done in a minimally invasive way – through the vagina or through small incisions in the abdomen.
However, in the new study, the researchers found that black and Hispanic women often did not undergo those less extensive procedures — instead undergoing a traditional surgery, with a large abdominal incision and hospital stay.
The reasons aren’t entirely clear, the researchers said.
But investigators have found that black and Hispanic women are less likely than white women to see a doctor who specializes in minimally invasive techniques.
The researcher, Dr.Dr. gynecologist At Cedars-Sinai Medical Center in Los Angeles.
Studies show that about 80% of black women develop uterine fibroids by age 50, as do 70% of white women. But black women usually develop them earlier: By some estimates, a quarter of black women develop fibroids by age 30.
They are also more likely to have multiple or large fibroids, have more severe symptoms, and have surgery more often than white women.
“This is one more reason we should try to reduce disparities in care,” Schneier said.
Traditional abdominal surgery to treat fibroids is generally safe. But it causes more pain and blood loss, and has a longer recovery time than minimally invasive procedures.
For the new study — recently published in Journal of Minimally Invasive Gynecology Schneier’s team examined the records of more than 1,300 women who underwent surgery for uterine fibroids at Cedars-Sinai in recent years.
Most underwent a myomectomy or minimally invasive hysterectomy, but there were significant racial gaps: Among white women, 81% underwent minimally invasive procedures, versus 57% of black women and 65% of Hispanic women. Meanwhile, Asian women had a similar rate to white women.
Schneier said there are times when traditional surgery is the best option, depending on the number of fibroids or the size of the uterus, for example.
The study found that these factors did not explain the disparity in the type of surgery.
Alternatively, black and Hispanic women were less likely than white women to see a doctor who specialized in minimally invasive techniques: they often saw an obstetrician/gynecologist without “subspecialty” training.
The reason is not clear, as all patients were treated at the same medical center and almost all had private insurance.
It’s possible that the doctors the black and Hispanic women initially saw were less likely to refer them to subspecialists, perhaps due to “implicit biases,” Schneier said.
But she suspects, “awareness inequalities” may play a larger role: White women may be more likely to learn less invasive options, or seek a second opinion.
Dr. Hee Chun-Hur is a minimally invasive gynecological surgeon at New York University Langone Hospital in Brooklyn. In her experience, she said, some patients with uterine fibroids are already more inclined to “doctor shopping” and seek a second or third opinion, while others accept the initial option offered to them.
Both Schneier and Hoare said the onus should fall on doctors to explain all treatment options.
It’s also important for primary care physicians and obstetricians and gynecologists — those who refer women to subspecialists — to realize that minimally invasive procedures can often be performed even when there are many fibroids or a large uterus, they said.
“A lot has changed in the past 20 years,” Schneier said. “Often, minimally invasive surgery is an option.”
For women who recommend traditional surgery, Hoare said, “seeking a second opinion is always a good idea.” She added that they should try to get this opinion from a specialist in minimally invasive techniques if possible.
Schneier also emphasized that non-surgical options are available, including drugs that control bleeding caused by fibroids.
Hoare said any treatment should be individualized — not just based on symptoms, but on the woman’s age and pregnancy plans.
She noted that fibroids sometimes affect fertility, so some young women may consider lumpectomy, even if they don’t have symptoms.
This may be especially important for black women, Hoare said, because they are more likely to develop many fibroids at a younger age.
The US Office of Women’s Health has more about uterine fibroids.
SOURCES: Rebecca Schneier, MD, obstetrics and gynecology, Cedars-Sinai Medical Center, Los Angeles; Hye-Chun Hur, MD, MPH, Director of Gynecology Services, NYU Langone Hospital Brooklyn, and Clinical Associate Professor, Obstetrics and Gynecology, NYU Grossman School of Medicine, New York City; Journal of Minimally Invasive GynecologyJuly 3, 2022, online