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Researchers establish prevalence of uterine cancer at time of hysterectomy with morcellation
A database analysis established for the first time the prevalence of uterine cancers among women at the time they undergo minimally invasive hysterectomy using electric power morcellation.
Results showed uterine cancers were present in 27 per 10,000 women at the time of the procedure. Other malignancies also were detected, and researchers determined the risks associated with underlying cancer and endometrial hyperplasia increased with age.
Jason D. Wright
“In an analysis of more than 36,000 treated at more than 500 hospitals across the United States with hysterectomy employing electric power morcellation … 1 in 368 women had an underlying cancer,” Jason D. Wright, MD, director of gynecologic oncology at Columbia University Medical Center, told HemOnc Today. “These findings are important for patients and clinicians as they gauge the risks and benefits of electric power morcellation at the time of hysterectomy.”
Hysterectomy requires removal of the uterus through small incisions. Morcellation — in which the uterus is fragmented into small pieces — is one common method of uterus removal, but federal regulators urged physicians in April to stop using power morcellators during hysterectomies because of their potential to spread undetected malignancies.
Wright and colleagues used the Perspective database — which encompasses about 15% of all hospitalizations in the United States — to calculate the prevalence of underlying cancer in women who underwent uterine morcellation.
The researchers identified 232,882 women who underwent minimally invasive hysterectomy between 2006 and 2012. Of those women, 36,470 (15.7%) underwent hysterectomy with electric power morcellation. Ninety-nine of these women presented with uterine cancer, for a prevalence of 27 (95% CI, 22-32) per 10,000 women.
Researchers identified 26 cases of other gynecologic malignancies (prevalence, 7/10,000; 95% CI, 4-10) and 39 cases of uterine neoplasms with uncertain malignant potential (prevalence, 11/10,000; 95% CI, 7-14). Also, 368 women presented with endometrial hyperplasia (prevalence, 101/10,000; 95% CI, 91-111).
Uterine cancer prevalence was highest among women aged at least 65 years compared with those aged younger than 40 years (prevalence ratio, 35.97; 95% CI, 14.14-91.53). Women aged 60 to 64 years (prevalence ratio, 21.36; 95% CI, 7.22-63.21), 55 to 59 years (prevalence ratio, 19.37; 95% CI, 7.66-48.95), and 50 to 54 years (prevalence ratio, 4.97; 95% CI, 1.91-12.93) also demonstrated increased uterine cancer prevalence compared with women aged younger than 40 years.
Increased age also was associated with endometrial hyperplasia. Compared with women aged younger than 40 years, prevalence ratios were 8.22 (5.45-12.39) among those aged 50 to 54 years, 9.38 (95% CI, 5.5-16) among those aged 60 to 64 years, and 10.21 (95% CI, 5.43-19.17) among women aged 65 years and older.
“Our study provides data on the prevalence of cancers in women who underwent electric power morcellation,” Wright said. “More studies are needed to examine whether morcellation increases the risk of spread of cancers that may be present in the uterus and, ultimately, whether morcellation impacts prognosis for the cancer.”
Jason D. Wright, MD, can be reached at Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., New York, NY 10032; email: jw2459@columbia.edu.
Disclosure: The researchers report no relevant financial disclosures.