More questions than answers?
The data presented by Wright and colleagues on the prevalence of underlying cancer in women who undergo myomectomy is disturbing and thought-provoking.
Are those in the 50-and-older age group who undergo myomectomy different from their same-aged peers with fibroids who do not undergo myomectomy? If so, why? If not, then with a 1 in 154 to 1 in 31 risk of occult malignancy, should not all women 50 years and older with fibroids undergo hysterectomy for this occult risk? This certainly has not been the standard of care for women 50 and older with asymptomatic fibroids. Thoughts?
In conclusion, it appears that power morcellation, or should I say the morcellation issue, has brought forth more questions than answers.
Richard L. Myers, MD
* Dr. Barbieri responds
I agree with Dr. Myers: Women aged 50 and older who have fibroids and undergo myomectomy must be clinically different than women of the same age who have fibroids but do not undergo myomectomy. It is likely that the women who undergo myomectomy have larger pelvic tumors or are more symptomatic than those who do not undergo myomectomy. I think this demonstrates that gynecologists are successfully identifying those women with a pelvic mass thought to be due to fibroids with the greatest risk of occult cancer and recommending that those women undergo surgery, while simultaneously recommending expectant management for those at lowest risk of an occult cancer.
"WHAT IS THE RISK THAT A PATIENT WILL HAVE AN OCCULT UTERINE CANCER AT MYOMECTOMY?"
ROBERT L. BARBIERI, MD (EXAMINING THE EVIDENCE; APRIL 2015)
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|Title Annotation:||Comment & Controversy|
|Author:||Myers, Richard L.|
|Article Type:||Letter to the editor|
|Date:||Jun 1, 2015|
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