Uterine cancer expert warns against morcellation, says dangers are known
A common surgical device, often used for minimally invasive hysterectomies, may be riskier than previously thought because of its potential to spread several types of cancer, not just uterine cancer, a new study has found.
One out of every 368 women treated with a power morcellator – a device that cuts the uterus into smaller pieces for easy removal – had unsuspected uterine cancer that was found during or after their procedures, the researchers showed. Other types of cancer were found as well, they reported, further reinforcing a government assessment that the device is risky. The discovery by Columbia University physicians, detailed in findings published online July 22 in the Journal of the American Medical Association, brings additional data and context to an issue of considerable debate in the gynecology and oncology communities for the last year. A study last December advised patients and their doctors to carefully discuss the risk and benefits of morcellation before reaching a decision about the procedure, which is a step in treating fibroids and facilitating minimally invasive hysterectomy. In April, the Food and Drug Administration advised doctors to avoid using power morcellators for hysterectomy or fibroid removal, saying that the device could spread previously undetected cancers in the body, significantly reducing a patient’s odds of survival.
“The study’s results aren’t surprising,” said Mark Wakabayashi, M.D., co-director of the Gynecological Oncology/Peritoneal Malignancy Program at City of Hope. “I’ve seen cases of this happening in the past, which is the main reason I have never used the power morcellator. The morcellator itself does not cause cancer, but if a cancer is present, it can seed the cancer in the abdominal cavity.”
The study from Columbia University College of Physicians and Surgeons used data from a large insurance database that included 500 hospitals and 15 percent of hospitalizations nationwide. Researchers analyzed data from 232,882 cases from 2006 to 2012 in which women underwent minimally invasive hysterectomies using various approaches, including 36,470 who had power morcellation. Of those women, 99 had uterine cancer that was detected afterward. Morcellation is not used in patients who have a known cancer.
This means that one in 368 women had cancerous tumors that risked being spread by morcellation – significantly higher than previous estimates which ranged from one in 500 to one in 10,000 cases.
The largest risk factor for the uterine cancers was age, the study found, with cases increasing steeply from 50-year-old women to those 65 and older. Women do have other options for minimally invasive hysterectomies. Power morcellation is not the only technique, and in fact was used in only about 16 percent of the minimally invasive hysterectomies studied.
In the wake of the study, some gynecologists have warned that the risks associated with power morcellation should not scare patients off from minimally invasive procedures, pointing out that open procedures also have significant risks and morbidities.
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