Black women are less likely to receive laparoscopic fibroid surgery

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By Amy Norton
Health Day Reporter

TUESDAY, September 6, 2022 (HealthDay News) — Surgery for uterine fibroids can often be performed through minimally invasive techniques that avoid hospitalization. But black and Hispanic women may be less likely to receive these treatments, a recent study shows.

Uterine fibroids are benign growths in the uterus. Sometimes they don’t cause problems, but when they do — like heavy monthly bleeding and pain — treatment may be needed.

One option is surgery: a myomectomy, in which only the fibroids are removed; or a hysterectomy, in which the uterus is removed. Both operations can often be performed minimally invasively – vaginally or through small incisions in the abdomen.

But in the new study, the researchers found that black and Hispanic women often didn’t get these less extensive procedures — instead, traditional surgery involving a large abdominal incision and hospitalization.

The reasons are not entirely clear, the researchers said.

But investigators found that black and Hispanic women were less likely than white women to see a doctor who specialized in minimally invasive techniques.

Uterine fibroids are very common, but mostly in black women, said researcher Dr. Rebecca Schneyer, an ob/gyn at Cedars-Sinai Medical Center in Los Angeles.

Studies show that about 80% of black women will have uterine fibroids by age 50, as will 70% of white women. But black women usually develop them earlier: by some estimates, a quarter of black women have fibroids by age 30.

They are also more prone to numerous or large fibroids, suffer more severe symptoms, and have more surgeries than white women.

“We should try all the more to reduce inequalities in care,” said Schneyer.

Traditional abdominal surgery for fibroids is generally safe. But it causes more pain and blood loss and has a longer recovery time than minimally invasive procedures.

For the new study – recently published in the Journal of Minimally Invasive Gynecology – Schneyer’s team examined records of more than 1,300 women who underwent surgery for uterine fibroids in Cedars-Sinai in recent years.

Most had a minimally invasive myomectomy or hysterectomy, but there were significant racial disparities: Among white women, 81% underwent minimally invasive procedures versus 57% of black women and 65% of Hispanic women. Asian women, meanwhile, had a rate comparable to white women.

Schneyer said there are times when traditional surgery is a better option, depending on the number of fibroids or the size of the uterus, for example.

But those factors didn’t explain the differences in the type of surgery, the study found.

Instead, black and Hispanic women were less likely than white women to see a doctor who specialized in minimally invasive techniques: they often went to an ob/gyn without that “underspecialty.”

Why is unclear, as all patients were treated at the same medical center and almost all were privately insured.

It’s possible, Schneyer said, that the doctors who initially saw Black and Hispanic women were less likely to refer them to subspecialists, perhaps because of “implicit bias.”

But she suspects “differences in consciousness” may play a bigger role: White women may be more likely to know about minimally invasive options or seek a second opinion.

dr Hye-Chun Hur specializes in minimally invasive gynecologic surgery at NYU Langone Hospital Brooklyn. She said that in her experience, some patients with uterine fibroids are actually more likely to “go to the doctor” and get second or third opinions, while others accept the initial option they are offered.

The responsibility should lie with physicians, Schneyer and Hur said, to explain all treatment options.

They said it’s also important that GPs and general gynecologists — those who refer women to subspecialists — are aware that minimally invasive procedures can often be performed even when fibroids are numerous or the uterus is large.

“A lot has changed in the past 20 years,” said Schneyer. “Most of the time, minimally invasive surgery is an option.”

For women recommended for traditional surgery, Hur said, “it’s always a good idea to get a second opinion.” But they should try to get that opinion from a specialist in minimally invasive techniques if possible, she added.

Schneyer also emphasized that nonsurgical options are available, including drugs that control bleeding caused by fibroids.

Any treatment, Hur said, needs to be individualized — based not only on the symptoms, but also on a woman’s age and pregnancy plans.

Sometimes fibroids affect fertility, she noted, so some young women might consider having the growths removed even if they’re not causing symptoms.

That could be especially important for black women, Hur says, because they’re at higher risk of developing multiple fibroids at a younger age.

More information

The US Office on Women’s Health has more on uterine fibroids.

SOURCES: Rebecca Schneyer, MD, Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles; Hye-Chun Hur, MD, MPH, Director, Gynecological Services, NYU Langone Hospital Brooklyn, and Associate Clinical Professor, Obstetrics and Gynecology, NYU Grossman School of Medicine, New York City; Journal of Minimally Invasive GynecologyJuly 3, 2022 online



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