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Worries Grow Over Uterine Procedure That May Spread Cancer

Jul 24, 2014

There is new evidence about the risk that a procedure performed on about 50,000 women a year during surgery to remove the uterus may spread cancer.

The power morcellation procedure uses a device to cut uterine tissue into pieces so that it can be removed through small incisions made during minimally invasive surgery, The New York Times reports. The procedure is also used to remove fibroid tumors. Recent reports indicate that when a morcellator sliced into tumors the doctors did not know existed, it could spread cancer cells through the abdomen.

A study published on Tuesday in the Journal of the American Medical Association, found that undetected tumors are more common than many experts had thought, and this conclusion may increase calls to limit or eliminate the use of power morcellators. In April, the Food and Drug Administration (FDA) said the procedure should be discouraged and this month the agency held hearings to evaluate morcellation.

The JAMA study analyzed a large insurance database of hospitalizations nationwide from 2006 to 2012. The researchers found 232,882 cases in which women underwent minimally invasive hysterectomies using various approaches; 36,470 women had power morcellation, the Times reports. Ninety-nine of those women had uterine cancer that was detected afterward, meaning that one in 368 women undergoing a hysterectomy had cancerous tumors that risked being spread by morcellation, according to the study’s lead author, Dr. Jason D. Wright, chief of gynecologic oncology at Columbia University College of Physicians and Surgeons.

Previous estimates of unsuspected cancer ranged from one in 500 to one in 10,000 cases. But a recent FDA analysis estimates that one in 352 women undergoing hysterectomy or fibroid removal have sarcomas, which are aggressive, hard-to-detect cancers. Age was the biggest risk factor for the uterine cancers, with cases increasing steeply from age 50 to 65 and older, according to the Times.

The researchers could not determine how women fared after morcellation, but recent cases suggest that it can spray pieces of tumor around, worsening the cancer, the Times reports. A review of cases at Dana-Farber Cancer Institute found that cancer spread significantly faster after morcellation than after major abdominal surgery to remove the uterus.

Dr. Wright did not necessarily call for morcellation to be banned, but said this “data is important to allow people to make decisions,” according to the Times.

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