Incidence of Undetected Cancer in Patients Undergoing Gynecologic Surgery for a Benign Condition Higher Than Estimated

At the time of gynecologic surgery for disease, an unsuspected cancer that was thought to be benign was found in 1 in 352 women. This study was published in the journal Women's Health Issues (doi:10.1016/j.whi.2015.09.008).

Minimally invasive gynecologic surgeries have advantages for patients, including shorter hospital stays, quicker recoveries, and less pain. However, power morcellation, a technique that cuts the uterus or fibroid into small pieces for extraction from the abdomen through a small incision, may worsen a woman's prognosis if the morcellated tissue is a cancer.

Using a national insurance database of 55 million women, Boston Medical Center (BMC) researchers in Massachusetts looked at cases from 19 500 women who underwent laparoscopic hysterectomies or myomectomies, procedures that typically incorporate power morcellation. They sought to determine how frequently cancer is diagnosed in women after undergoing gynecologic surgery for a problem believed to be benign.

"Our findings show that the risk for morcellating cancer is much higher than previously understood," said senior author Michael Paasche-Orlow, MD, MPH, general internal medicine physician at BMC and associate professor of medicine at Boston University School of Medicine (BUSM). "It makes sense to avoid morcellation for women with cancerous or precancerous lesions. As it is difficult to ascertain in advance, safer alternatives are needed."

The study also determined that more than half of the patients who received a diagnosis of uterine cancer or endometrial hyperplasia, a precancerous condition of the lining of the uterus, did not undergo endometrial testing prior to surgery. Thus, researchers suggest improving how physicians evaluate patients undergoing hysterectomies or myomectomies before they reach the operating room.

"We are continually seeking opportunities to move gynecologic surgery forward," said lead author Rebecca Perkins, MD, a practicing gynecologist at BMC and associate professor of obstetrics and gynecology at BUSM. "Because minimally invasive surgery has many advantages, future research should seek to improve techniques to create safer procedures for women."

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