It’s a sad state of affairs in the surgery world. I’m on my way back from the ASRM meeting, our national fertility society. There was some discussion of fibroids from various angles including radiologic uterine artery embolization, a non-surgical treatment for fibroids. The real argument with the Power Morcellator is whether the fibroid could be a cancer or not before it is morcellated (cut into small pieces to get it out of the abdomen) during the surgery. In the over 125 years or so that fibroids have been being removed, gynecologists have not considered them to be a malignant process. Data today would suggest that the incidence of a cancerous fibroid in reproductive age women is less than 1 in 2000 cases. Some believe it’s far less than that. Currently, strategies are being tested to treat fibroids with medications, radiofrequency (heat) and freezing (cold) as well as the now long utilized uterine artery occlusion procedure to “kill” the fibroid.
All of these procedures leave the fibroid in the body, so if we are going to make major decisions regarding surgical approaches worrying about cancer, then there should never be any non-surgical approach to fibroids. This is because, we would always need to make sure it’s not a cancer. The logic is extremely faulty and the current “scare” with the morcellation procedure that allows us to remove large tissue through a small hole was started by a high profile, very political case. Anytime a surgeon operates, there could be cancer, but we don’t change the operation for that rare risk. This rational logic pointing out that we don’t rush in for every fibroid because we are worried about cancer was very astutely offered by a member of the audience in a fibroid symposium in the meeting.
Overreaction, and concern over legal risk, has pushed our system to the edge of the cliff. Doctors find it very difficult to provide rational care that’s in the best interest of the patient in today’s highly regulated world. We continue to pursue a rational approach to care and work hard to educate patients about risk and options in their individual care.