Fibroid Embolisation: So Promising for Women, So Unavailable in Europe
Cynthia E. Keen reports from ECR
Uterine fibroids are the most common form of benign pelvic tumor, with about 30-50% of women between the ages of 35-45 years reporting them. Although many women are asymptomatic, those who experience the symptoms of bladder pressure, frequent and very heavy menstrual periods, and uterine pain, have a reduced quality of life.
The common treatment is a hysterectomy. In Germany, of the 134,000 hysterectomies performed in 2005, approximately 99,000 were related to fibroids. Hysterectomies not only terminate opportunities for childbearing, the operation requires a five day hospital stay with a typical recovery period of eight weeks. The emotional and societal costs are significant.
An alternative exists: uterine artery embolisation (UAE). This minimally invasive procedure was developed in France in 1995. Since its invention, more than 150,000 women had the procedure, Dr. Anthony Nicholson, a consultant radiology at Leeds General Infirmary in the United Kingdom told ESR meeting attendees.
In Germany, however, only 3,000-4,000 embolisation procedures were performed, according to Professor Jean-Pierre Pelage, M.D., Ph.D., a radiologist who is affiliated with the Department of Radiology and Gynecology of L’Hopital Ambroise Pare in Boulogne, France and Associate Professor of Radiology at the Université of Paris Ouest. He said that gynecologists of most European countries, including France, have little interest in suggesting these procedures because they are performed by interventional radiologists. Gynaecologists receive a significant percentage of their fees for performing hysterectomies, he noted.
Mrs. Victoria Norton, a patient advocate who founded Forum Myome (http://de.groups.yahoo.com/group/myome), a web-based support group for women with symptomatic uterine fibroids, explained that women must ask for this treatment. “To do that, they must know the procedure exists, and if it is not talked about, that is very difficult. Then they must persuade their physician to refer them to a specialized multi-disciplinary center that will properly evaluate them to see if the woman is an appropriate candidate for this procedure.”
The dominant mass of a fibroid must be less than 10 cm in diameter. Large, pedunculated subserosal fibroids should not be treated by UAE, Dr. Pelage said. UAE may also reduce the ability to become pregnant. Dr. Willem Anukum, a gynaecologist at the Academic Medical Center in Amsterdam, said that clinical trial data revealed that patients who had a myomectomy were 28% more likely to become pregnant and would experience fewer miscarriages than women who underwent UAE. 20% of women who have a UAE procedure will require a subsequent hysterectomy.
Based on his experience, Dr. Pelage said that UAE is very effective for 85% of the patients who have the procedure. He said that there is a low risk of complications as long as there is conscientious follow-up by the physician of a patient. Only local anesthesia of the groin is required, and the patient spends only one day in a hospital. A typical recovery period is 20 days.
In addition to reluctance by gynaecologists to recommend UAE, there is a shortage throughout Europe of interventional radiologists to perform the procedure. There also are few medical centers with the multi-disciplinary physician teams required to evaluate and treat patients.
“It is far easier for a gynaecologist, usually a man, to recommend a hysterectomy and not think of the other potential options,” Mrs. Norton said. “But for many of us, UAE provides a better overall quality of life, with the potential for pregnancy and a guarantee that our sexual function will not be diminished, as is reported by 20% of women who have hysterectomies.”