Seeking a second and third opinion reduced the number of hysterectomies carried out to treat uterine fibroids, according to a single-center study published in the open access Journal of Therapeutic Ultrasound.
Fibroids are non-cancerous tumors that occur in the uterus of 20-35% of all reproductive-age women. They are made of muscle and fibrous tissue and can occur in multiple locations in the womb. The most common forms of treatment for this condition are surgical removal of the tumors, minimally invasive surgery, focused ultrasound and hysterectomy. In the United States, of the women that undergo treatment, 70% have a hysterectomy based on the advice of their physician.
UCLA researchers at a multidisciplinary fibroid center investigated the treatment pathways of women who came to their clinic for a second opinion. The study period covered the period from July 2008 to August 2011, and involved 205 women with an average age of 44 years old. Most of the women who attended the clinic had already been diagnosed as having uterine fibroids and most had been offered hysterectomy as a form of treatment.
When the women arrived at the clinic they had a consultation with a gynecologist and a radiologist separately. The women then underwent an MRI, which can identify the three different types of fibroids better than ultrasound or CT scans. The results of the MRI scan were then assessed jointly by the gynecologist and radiologist. Treatments were then offered based on the patient’s history, the physical examination, MRI, and the patient’s treatment request.
Nelly Tan, lead author of the study, says: “In the multidisciplinary fibroid center, women are evaluated jointly by an interventional radiologist and a gynecologist, which is different from standard evaluation which involves only an evaluation by a gynecologist or a primary doctor. Our patient population is different from the typical patient presenting to a doctor's office because our patients already have had a diagnosis of fibroids and seek us out for a second or third opinion.”
Of the 205 women who were included in this study, 109 decided to transfer their care to the multidisciplinary fibroid center. When these figures were broken down, 24 had no treatment or non-medical therapy, and 76 underwent uterine preserving procedures. Only 8 of the109 had a hysterectomy, this figure represents 7.3% of the women who transferred their care to the clinic, compared to the national figure for the US where 70% receive hysterectomy to treat fibroids.
There are limitations to this study. There may be bias in the women who referred to this clinic as they were likely to have a preference for uterine preserving treatment after doing some investigation in looking for a second opinion. The treatments offered in this clinic such as MRI, focused ultrasound, and keyhole surgery may not be available at general clinics so the results cannot be generalizable.
Nelly Tam says: “Most patients undergo hysterectomy for fibroids but this does not have to be the case. The difficulty for patients is lack of information and limited access to certain treatment options due to geography. But, now through the internet, patients seek out more information about possible treatment and find us. Ultimately, with fewer barriers to medical information, patients could be the driving force for adoption of minimally invasive uterine-preserving therapies.”
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Notes to Editor
1. Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center
Nelly Tan, Timothy D McClure, Christopher Tarnay, Michael T Johnson, David SK Lu and Steven S Raman
Journal of Therapeutic Ultrasound 2014, 2:3
Article available at journal website here.
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