The prevalence of uterine cancer and precancerous abnormalities of the uterus was low overall in women who underwent fibroid tumor removal with or without electric power morcellation, a procedure that has caused concern because the uterus is fragmented into smaller pieces and that may result in the spread of undetected malignancies, according to a study published online by JAMA Oncology.1
Fibroids (uterine leiomyomas) are commonly benign tumors of the uterus and the definitive treatment for them is either by removal of the uterus in a hysterectomy or removal of the fibroids in a myomectomy for women who want to preserve the uterus. The use of electric power morcellators came under scrutiny when a patient with a presumed fibroid tumor underwent a hysterectomy with electric power morcellation and was instead found to have a uterine cancer that spread. The case has led to increased recognition that while fibroid tumors are commonly benign, the tumors can also be unrecognized cancer, according to the study background.
Jason D. Wright, M.D., of Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, and coauthors analyzed the prevalence of underlying cancer and precancerous changes in women who underwent myomectomy with and without electric power morcellation. The authors analyzed data from 41,777 women who underwent myomectomy at 496 hospitals and they included 3,220 (7.7 percent) women who had electric power morcellation.
According to the results, uterine cancer was identified in 76 women. The prevalence of uterine cancer was 0.19 percent in women who underwent myomectomy without morcellation (73 women or 1 in 528) and 0.09 percent in women who had electric power morcellation (three women or 1 in 1,073).
The prevalence of pathologic findings increased with age. Among women who underwent myomectomy without morcellation, uterine cancer was seen in 0.05 percent of women younger than 40; rose to 0.62 percent of women between the ages of 50 and 59; and increased again to 3.4 percent in women 60 or older. The prevalence of uterine cancer in women who had myomectomy with electric power morcellation was 0 percent in women younger than 40; 0.97 percent in women 50 to 59; and 0 percent in women 60 or older.
“Given that older women are at the greatest risk for pathologic abnormalities, electric power morcellation should be approached with caution in patients older than 50 years undergoing myomectomy. The frequency of use of electric power morcellators for gynecologic surgery first increased rapidly with a relative lack of data and then abruptly decreased after an adverse outcome in a young woman. These events highlight the difficulty of evaluating, using and marketing surgical devices. From a public health perspective, these findings highlight the need for more rigorous comparative effectiveness research and heightened regulatory oversight for new devices and procedures,” the study concludes.
In a related commentary2, Ceana Nezhat, M.D., of the Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, writes: “In this issue of JAMA Oncology, Wright and colleagues report their analysis concerning the prevalence of undetected cancer and precancerous changes in women who underwent myomectomy with and without EMM [electromechanical morcellation]. In light of the limited data regarding safety and risks in women undergoing myomectomy with EMM, this report broadens the focus on this matter.”
“Owing to lack of information regarding the risk of occult uterine malignant neoplasms in reproductive-age women and possible tumor dissemination during myomectomy, with or without morcellation, the magnitude of harm is unknown. Consequently, not only morcellation, but the prevalence of malignant and premalignant uterine lesions in younger patients calls for investigation,” the author writes.
1. JAMA Oncol. Published online February 19, 2015. doi:10.1001/jamaoncol.2014.206.
2. JAMA Oncol. Published online February 19, 2015. doi:10.1001/jamaoncol.2014.184.