Undetected cancer among women undergoing gynecologic surgery more common than previously thought

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

Using a national insurance database of 55 million women, Boston Medical Center (BMC) researchers looked at cases from 19,500 women who underwent laparoscopic hysterectomies or myomectomies -- procedures which typically incorporate power morcellation -- to determine how frequently women are diagnosed with cancer after undergoing a gynecologic surgery for a problem that is believed to be benign. The study revealed that 1 in 352 women had an unsuspected cancer at the time of gynecologic surgery for disease that was thought to be benign. The study is published online in advance of print in the journal Women's Health Issues.

"Our findings show that the risk for morcellating cancer is much higher than previously understood," said Michael Paasche-Orlow, MD, MPH, general internal medicine physician at BMC and associate professor of medicine at Boston University School of Medicine (BUSM) who is the study's senior author. "It makes sense to avoid morcellation for women with cancerous or pre-cancerous 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 were diagnosed with uterine cancer or endometrial hyperplasia, a pre-cancerous 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 Rebecca Perkins, MD, a practicing gynecologist at BMC and associate professor of obstetrics and gynecology at BUSM who is the study's lead author. "Because minimally invasive surgery has many advantages, future research should seek to improve techniques to create safer procedures for women."