Today I put my patient safety hat on to discuss a growing controversy in the obgyn community about the treatment of fibroids. Fibroids are usually a benign tumor that affects 80% of women and especially African American women. They can sometimes cause bleeding, pain and press on internal organs. If the problems are severe and a woman desires no more children, they are removed via a hysterectomy. However, if the hysterectomy is done via a laparoscopy (or the “Bandaid” surgery), the fibroids have to be cut into smaller pieces before removal, a process called “morcellation.” Unfortunately a small percentage of fibroids are cancerous and there is an increase risk of spreading cancer when morcellation is done. This problem hit the radar screen when a physician, Dr. Amy Reed, mother of 6 children who are under the age of 13, had a hysterectomy for fibroid tumors that was subsequently diagnosed as cancer. Because she had a morcellation procedure, the cancer spread to an advanced stage giving her an 85% chance of being dead within 5 years. Reed an her husband, Dr. Hooman Noorchashm, a heart surgeon, are trying to stop the procedure from being performed on future patients.
The medical community is now debating whether morcellation should continue and the FDA has strongly encouraged its ban. Laparascopic surgery is often used by gynecologists because of its convenience, short hospital stay and decreased healing time. However, it now faces an uncertain future based on Reed’s case.
For women who have fibroids, please do your homework before allowing someone to take you into the operating room. Make your surgeon aware, that you’re aware of the potential complications if morcellation is done. Encourage them to take a small sample to send to the pathologists at the beginning of your procedure before any major incisions into the uterus is done.
It is easier to prevent a mistake, than try to correct it after the fact.