Study Details Uterine Cancer Prevalence at Hysterectomy with Morcellation — Physician’s First Watch
Study Details Uterine Cancer Prevalence at Hysterectomy with Morcellation
By Andrew M. Kaunitz, MD
Older women are much more likely than younger patients to have undiagnosed uterine cancer at the time of hysterectomy with morcellation, according to a research letter in JAMA. (In morcellation, the uterus or fibroids are cut into smaller pieces for easier removal — a procedure that can spread undetected uterine sarcoma into the abdomen and pelvis, the FDA recently warned.)
U.S. investigators analyzed an insurance database including over 230,000 women who had minimally invasive hysterectomies between 2006 and 2012. Among the 16% of women who underwent morcellation, 99 cases of uterine cancer were observed (prevalence, 27/10,000). Other gynecologic neoplasia (including cervical, ovarian, and tubal malignancies as well as endometrial hyperplasia) were identified in an additional 26 women (7/10,000).
Risk for uterine malignancy rose with age: Compared with women younger than 40, risk was 5 times higher in women aged 50 to 54 and 36 times higher in those 65 or older.
We await the recommendations of an FDA panel that is currently reviewing the practice of morcellation for minimally invasive hysterectomy. Meanwhile, in contemplating how these data will inform our decisions about approaches to hysterectomy, I find the marked association between age and risk for malignancy to be particularly relevant.
Dr. Kaunitz is editor-in-chief of NEJM Journal Watch Women's Health, from which this story is adapted.