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Docs Don't Level With Women About Hysterectomies

Many perform more drastic surgery than may be needed, study says

(HealthDay is the new name for HealthScoutNews.)

THURSDAY, Aug. 7, 2003 (HealthDayNews) -- If you need a hysterectomy, can you count on your doctor to tell you the truth about all your surgical options?

The answer may be an alarming "no" -- at least according to a study in the August issue of Obstetrics and Gynecology.

In a survey of nearly 800 gynecologists in the Maryland, Virginia and Washington, D.C., area, researchers from Georgetown University Medical Center found that nearly 50 percent acknowledged routinely performing a more dramatic form of hysterectomy than may be medically necessary.

And more than 60 percent acknowledged they didn't give their patients the option of considering a less drastic surgical choice that would keep the cervix intact.

"This, to our knowledge, is the first survey to be carried out in the United States of views of gynecologists regarding removal or conservation of the cervix at hysterectomy for benign disease," writes author Dr. Nadine Zakem, a physician at Georgetown University at the time of the study.

The researchers caution, however, that their findings may not be representative of practices and policies of gynecologists nationwide.

Hysterectomies can be performed in a number of ways. The subject of this survey focused on just two: The "total" hysterectomy, which removes the uterus and cervix through a major abdominal incision, and the subtotal or "supracervical" hysterectomy, which removes only the uterus, usually through the vagina.

Although the debate surrounding unnecessary hysterectomies has generated headlines in recent years, a quieter controversy over these two surgical approaches has been smoldering within the medical community for some time.

At the heart of the debate, and this study, is which of the two procedures is appropriate for women with benign uterine disease, with no clear-cut sign or risk of cervical cancer.

"More recently, the debate has grown somewhat louder, with voices on both sides of the issue coming to the forefront," says Dr. Steve Goldstein, a professor of obstetrics and gynecology at New York University School of Medicine.

As Goldstein explains it, those in favor of removing the cervix continue to believe the traditional idea that doing so reduces a woman's future threat of cervical cancer, and may eliminate future pelvic pain and bleeding.

Meanwhile, those in favor of the less drastic procedure point to recent studies showing that preserving the cervix may play an important role in preserving urinary, bowel and sexual activity -- functions often damaged by a total hysterectomy. Studies also show the subtotal hysterectomy is a less dramatic form of surgery with a faster recovery, shorter hospital stay and reduced risk of postoperative complications, as well as no visible scar.

In Goldstein's view, the new survey sounds an alarm that women shouldn't ignore.

"What makes this survey so especially disturbing is not just that the doctors were making a choice for their patients without consulting them, but that they chose a surgical option that I believe most women would never choose for themselves, if they were told the truth about their options," he says.

The anonymous 18-question survey was mailed to 1,647 gynecologists, and 770 responded.

Forty-five percent said they routinely removed the cervix with every hysterectomy for benign uterine disease. Their reason, the study authors say, was "to eliminate the risk of cervical cancer," even though 88 percent acknowledged the risk of cervical cancer in their patients was small or negligible.

And, while 17.8 percent of the doctors said they always counseled women regarding all their surgical options, 63 percent said they rarely or never did. Female doctors were as likely as male doctors not to tell women about all their options, as were older and younger doctors.

Approximately 600,000 hysterectomies are performed each year in the United States. It is second only to Caesarean delivery as the most frequently performed major abdominal surgery in women. Previous studies show 98 percent of all hysterectomies involve removing the cervix.

More information

To learn more about the various types of hysterectomies, visit the American College of Surgeons. For more information on alternatives to hysterectomy, check with the U.S. Food and Drug Administration.

SOURCES: Steve Goldstein, M.D., professor, obstetrics and gynecology, New York University Medical Center, New York City; August 2003 Obstetrics and Gynecology
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