Black, Asian women at increased risk for asymptomatic uterine fibroids vs. white women
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ANAHEIM, Calif. — Among U.S. residents, Black and Asian women of reproductive age were more likely to have asymptomatic uterine fibroids compared with their white and Hispanic peers, according to data presented here.
“Fibroids are the most common benign neoplasm in the female reproductive tract and can cause significant morbidity both in terms of quality of life (heavy menstrual bleeding, pelvic bulk symptoms) as well as reproductive health (subfertility, pregnancy loss, adverse obstetric/neonatal outcomes),” David Huang, MD, a clinical fellow at the UCSF Center for Reproductive Health, told Healio. “However, knowledge regarding the true prevalence of fibroids is limited, as prior studies mainly evaluated symptomatic white and Black women based on symptoms and surgical specimen.”
Huang and colleagues prospectively enrolled 996 women aged 25 to 45 years who were not seeking treatment for any medical condition. All participants reported regular menses, did not report using medications containing estrogen or progestin in the 3 months before the study and reported no history of ovarian or uterine surgery.
In total, 281 white, 249 Black, 229 Asian and 237 Hispanic women underwent transvaginal ultrasound. Fibroids were prevalent in 10.7% of white, 35.7% of Black, 21.8% of Asian and 12.7% of Hispanic women. Among women with fibroids, 34.5% of white, 48.3% of Black, 26% of Asian and 33.3% of Hispanic women had multiple fibroids.
Adjustment for BMI and age revealed that — compared with white women — the likelihood of fibroids was higher among Black (OR = 4.1; 95% CI, 2.46-6.85) and Asian (OR = 2.61; 95% CI, 1.57-4.33) women. According to Huang, the disparity in fibroid prevalence between white and Asian women — specifically Chinese women — was surprising given that it has not been described in previous research.
Additional analyses showed that the largest fibroid diameters were 3.16 ± 1.65 cm among white, 3.9 ± 1.86 cm among Black, 3.21 ± 1.59 cm among Asian and 2.97 ± 1.36 cm among Hispanic women (P = .03).
“Our findings highlight the importance that all providers who take care of women need to be cognizant of how common fibroids are, and how they could adversely affect women's reproductive and long-term health,” Huang said. “By identifying groups that are disproportionately impacted by this pathology, our hope is that this information could be used both clinically as well as from a research trial recruitment perspective to lessen health disparities.”
Given that Black and Asian women have worse IVF outcomes vs. white women, more studies are needed to see which fibroids impact IVF outcomes most, “which can then provide the information needed for surgical research to demonstrate benefit of myomectomy for ‘high-risk’ fibroids,” Huang said.
“There is also tremendous work being done on the basic science level to understand how fibroids affect the genetic pathways of the human endometrium,” he said. “I would love to and be excited to read more about fibroids in the basic science realm.”