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Shhhhh! Gynecologists Are Mum on New Fibroid Treatment

Surveys show women aren't being told of this simple, effective option

MONDAY, April 8 , 2002 (HealthDayNews) -- There's a highly effective new treatment available for fibroid tumors, but don't expect to hear about it from your gynecologist.

The radiological procedure, called a uterine fibroid embolization (UFE), is relatively simple and has been shown to be as effective as more dramatic procedures, such as a hysterectomy, for treating fibroid tumors. However, new research shows most gynecologists are mum on it.

"Only about one in 10 women in our study heard about the procedure from their gynecologist. And more than half were told they needed a hysterectomy to solve their problems, when, in fact, they didn't," says study author Dr. Robert Vogelzang, chief of radiology at Northwestern Memorial Hospital in Chicago. His research was presented today at the Society of Cardiovascular and Interventional Radiology's annual meeting in Baltimore.

A survey of 100 women who had UFE at Northwestern Memorial found that: 79 percent hadn't been told about the procedure by their gynecologist; 64 percent said their gynecologist recommended a hysterectomy; and 23 percent said their gynecologist recommended a myomectomy, an equally dramatic surgery that removes each fibroid.

According to Vogelzang, only 13 doctors recommended UFE to their patients. The rest, he says, either admitted not knowing about the procedure or, "at worst, they said the procedure was ineffective."

Several women in the study reported being told UFE would result in severe pain for several weeks -- a complication that never occurred during the study, Vogelzang adds.

In related research at Northwestern University, only 9 percent of women were referred by doctors for UFE, with 69 percent seeking out the procedure on their own after finding out about it through magazine or newspaper articles or from friends.

The results don't surprise radiologist Dr. Richard Rosen, who says most of his UFE patients don't hear about the treatment option from their doctor.

"I would say 70 to 80 percent of the patients I see are self-referred -- and they have discussed it with their gynecologists, who have discouraged them from this procedure," says Rosen, director of interventional radiology at New York University Medical Center.

Fibroid tumors are usually benign growths that develop in and around the uterus. They range in size from a quarter of an inch to larger than a melon, and are considered one of the most common health problems affecting women today. Up to 40 percent of women who are 35 and older have uterine fibroids of a significant size.

The most commonly recommended treatment is a hysterectomy, an operation that completely removes the uterus. Of the 600,000 hysterectomies performed each year, up to one-third are performed for fibroid tumors.

A second surgery, the myomectomy, removes only the fibroids. Although less drastic than a hysterectomy, this surgery is still considered a major operation, requiring hospitalization and a recovery period of up to several weeks.

By comparison, UFE is a relatively simple procedure in which a tiny incision is made in the groin, large enough to insert a tiny catheter. The tube is guided through the artery to the uterus until it reaches the fibroid. The radiologist then injects tiny particles, about the size of a grain of sand, into the blood vessels that feed the tumors, thus blocking blood flow.

"Once the blood supply is cut off to the tumor, it can't survive," Vogelzang says. Eventually, it shrivels and dies.

UFE requires no major incision, a hospital stay of only one night, and a short recovery period, with most women returning to normal activities within one week.

So, why aren't gynecologists telling their patients about this treatment option? The answer depends on whom you ask.

Vogelzang believes the most logical reason is that radiologists perform UFE, so gynecologists are simply unaware of its widespread use and success.

"It's not really so unusual that one medical specialty is not aware of what's going on in another medical specialty," Vogelzang says.

Rosen also says this is true. However, he adds that, on a personal level, he believes some doctors reject the procedure simply because they aren't the ones doing it.

"It's somewhat threatening to them -- non-gynecologists treating what is probably one of the commonest gynecologic problems. That's not easy for some doctors to accept," Rosen says.

UFE was developed in 1996 and since then, there have been more than 50 published medical papers attesting to its effectiveness.

What To Do

To learn more about UFE, visit Georgetown University Hospital.

For a comprehensive look at fibroid tumors and treatment options, visit The National Library of Medicine.

SOURCES: Robert Vogelzang, M.D., chief, radiology, Northwestern Memorial Hospital, and professor, radiology, Northwestern University Medical School, Chicago; Richard Rosen, M.D., director, interventional radiology, New York University Medical Center, and associate professor, radiology, New York University School of Medicine; April 8, 2002, study presentation, Society of Cardiovascular and Interventional Radiology annual meeting, Baltimore
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