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Black Women Less Likely to Get Laparoscopic Fibroid Surgeries

By Amy Norton
HealthDay Reporter

TUESDAY, Sept. 6, 2022 (HealthDay News) — Surgery for uterine fibroids can often be done through minimally invasive techniques that avoid a hospital stay. But black and Hispanic women are less likely to receive these treatments, a recent study finds.

Uterine fibroids are noncancerous growths in the uterus. Sometimes they don’t cause any problems, but when they do — such as 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 surgeries can often be performed in a minimally invasive manner — vaginally or through small incisions in the abdomen.

But in the new study, researchers found that black and Hispanic women who had less extensive procedures often didn’t have — instead, they got a traditional surgery, which involved a large incision in the abdomen and a hospital stay.

The reasons aren’t entirely clear, the researchers said.

But the researchers 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 common, but especially in black women, said study researcher Dr. Rebecca Schneyer, an obstetrician/gynecologist 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 tend to develop them earlier: By some estimates, a quarter of black women will have fibroids by age 30.

They are also more prone to having numerous or large fibroids, have more intense symptoms, and undergo surgery more often compared to white women.

“That’s all the more reason why we should try to reduce inequalities in care,” Schneyer said.

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 data from more than 1,300 women who had undergone surgery for fibroids in Cedars-Sinai in recent years.

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

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

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 saw an obstetrician/gynecologist without that “subspecialty” training.

Why is unclear, as all patients were treated in the same medical center and almost all had private insurance.

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 “disparities in consciousness” may play a bigger role: White women are more likely to be aware of minimally invasive options or to 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 indeed more likely to go to the doctor and ask for a second or third opinion, while others accept the first option presented to them.

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

It’s also important, they said, for primary care physicians and general gynecologists — those who refer women to subspecialists — to be aware that minimally invasive procedures can often be performed even if there are many fibroids or the uterus is large.

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

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

Schneyer also emphasized that there are non-surgical options available, including drugs that control bleeding caused by fibroids.

Any treatment, Hur said, should be individualized — not just based on symptoms, but also on a woman’s age and pregnancy plans.

Sometimes fibroids affect fertility, she noted, so some young women may consider having the growths removed even if they aren’t causing symptoms.

That may be especially important, Hur said, for black women, because they’re at a higher risk of developing numerous fibroids at a younger age.

More information

The US Office on Women’s Health has more about 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 clinical associate professor of obstetrics and gynecology, NYU Grossman School of Medicine, New York City; Journal of Minimally Invasive GynecologyJuly 3, 2022, online