Almost half of women diagnosed with uterine fibroids have never heard of uterine fibroid embolization (UFE), and less than half of those who were familiar with the procedure learned about it from their obstetrician/gynecologist, according to a new survey.
The survey, conducted by the Harris Poll for the Society of Interventional Radiology (SIR), revealed many gaps in knowledge, and misperceptions, according to Janice Newsome, MD, an interventional radiologist at the Emory School of Medicine, Atlanta, Georgia.
“What we found was surprising,” said Dr Newsome in a briefing about the survey.
Citing data from the National Institutes of Health, the SIR said in a news release that 75% of women will develop uterine fibroids by age 50 years. Those at increased risk are women who are overweight, are African American, are older than age 40 years, have high blood pressure, have had no children, and have first-degree relatives with fibroids.
Studies have shown that UFE is as effective as hysterectomy, with fewer complications. But the story continues to be that UFE, also known as uterine artery embolization, is still “vastly underutilized,” said Suresh Vedantham, MD, president of the SIR.
Data from the National Inpatient Sample (based on claims from all payers) presented at SIR’s annual meeting in March found that in 2012-2013, 167,650 hysterectomies were performed, compared with just 2470 UFEs.
The new SIR survey found that not only did 57% of women think they were not at risk for fibroids, but 62% had never heard of UFE, and one in five thought that hysterectomy was the only treatment for fibroids. Clinicians, specifically ob/gyns, may not be telling their patients about UFE because 73% of those who were familiar with the procedure said they had learned about it from other sources, including friends and family and their own research.
The American College of Obstetricians and Gynecologists (ACOG) said, however, that it urges its members to consider all possibilities. “Our guidance on treatment of fibroids is comprehensive, providing numerous non-surgical and surgical options for the treatment of fibroids,” said an ACOG spokesman, noting that the procedure was highlighted as one of those options in a 2008 practice bulletin that was reaffirmed in 2016. “Based on long- and short-term outcomes, uterine artery embolization is a safe and effective option for appropriately selected women who wish to retain their uteri,” concluded the bulletin.
ACOG also highlights the procedure as an option on its FAQ page on uterine fibroids when that is meant for patients.
Is Surgery Necessary?
The Centers for Disease Control and Prevention has estimated that 600,000 hysterectomies are performed in the United States each year, and some 300,000 are for benign disease, such as fibroids, said Dr Newsome. A majority of patients offered hysterectomy are eligible for nonsurgical treatment, including UFE, Dr Newsome told Medscape Medical News.
According to the SIR report that accompanied its survey, a study (Am J Obstet Gynecol. 2015;212:304.e1-304.e7) showed that medical records for one in five women who had a hysterectomy for a noncancerous condition did not support the need for surgery, and 40% of those who had the procedure for a noncancerous condition did not receive other treatments before the hysterectomy.
Dr Newsome called it “astounding” that women are being offered organ removal as the only option for benign disease.
James Spies, MD, MPH, a professor of radiology at Georgetown University Medical Center, Washington, DC, and the president-elect of SIR, said at the briefing that sometimes patients who have found him on their own are also seeking new gynecologists because they feel let down. But he said he usually refers patients back to ob/gyns for long-term, regular care. “We’re not regular providers of gynecologic care — none of us have that ambition,” said Dr Spies.
Some gynecologists may lack knowledge about UFE or are holding on to outdated information about the procedure, said Dr Spies.
“Unfortunately, still many health care professionals start and end with hysterectomy as the recommendation for patients,” he said.
Dr Spies noted that many of UFE’s benefits dovetail with patients’ desire. It has a short postprocedure recovery of 7 to 10 days, has small risk for complications, and preserves the uterus. He said that 90% to 95% of women with fibroids technically would be candidates for UFE, but that it requires discussion. UFE is ideal for women who are too obese for surgery.
It should not be done in women who are pregnant but can possibly be performed in those who still wish to have children, he said.
A new approach that seems to be more comfortable for patients and results in faster recovery — through the wrist, rather than the groin — is being used more often, especially at Emory, said Dr Newsome. That could interest more clinicians and patients in the procedure, she said.
There’s a 20% to 25% chance that symptoms requiring treatment could recur 5 years after the procedure, but that’s also true of surgery, Dr Spies said.
“It’s the nature of the condition — the regrowing of the fibroids,” he said.
A second UFE is not contraindicated, said Dr Spies.
Self-Interest?
Is it self-interested for interventional radiologists to be promoting UFE? “I think that is a very fair question,” said Dr Newsome.
But she said that SIR was trying to promote awareness and the best possible care for patients. Dr Newsome noted that the survey showed that women believed that being informed of all possible options was the most important factor in selecting a treatment.
Almost a third of patients who come to her practice do not end up receiving UFE, said Dr Newsome.
This is “not so much a competition,” she said. “We really should be collaborators for a disease that is truly so prevalent and ravishes so many women without them knowing anything at all about it,” said Dr Newsome.
The survey was conducted online by the Harris Poll for the SIR between June 23 and 27, 2017, among 1176 US women aged 18 years or older.
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