Black women at any age who have uterine myomatacommonly called fibroidsare more likely to have them surgically removed through a myomectomy, a procedure that preserves the uterus, than are white or Hispanic women with fibroids. While research by the Duke University Evidence-based Practice Center (EPC) on the management of uterine fibroids, sponsored by the Agency for Healthcare Research and Quality (AHRQ), confirmed earlier studies that showed that black women have higher rates of hysterectomysurgical removal of the uterusthan any other racial group, the EPC found that black women also have higher rates of myomectomy.
The incidence of fibroids is higher in black women than in other racial groups, and black women tend to have larger and more numerous fibroids when first diagnosed, so they are more likely to need treatment than any other racial group. The rate of hysterectomies among black women with fibroids is higher than that for white women (50 percent versus 30 percent), but the EPC found that black women are more likely than women of other racial groups to undergo surgery, either by myomectomy or hysterectomy, to treat their fibroids. The EPC researchers conclude that the high rate of hysterectomy among black women with fibroids does not appear to be because they are not offered more conservative surgery. The scope of the report did not include an examination of reasons why black women have so many hysterectomies in general.
The EPC reviewed the available research on benefits, risks, and costs of commonly used medical therapies for uterine fibroids, and found that the majority of the published literature did not provide clear answers about optimal treatments. The researchers found tremendous differences in incidence and outcomes among racial groups, and they urge that more research be conducted to provide clear evidence to help women make informed decisions about the best treatment for their situation.
The summary, Management of Uterine Fibroids, is available through the AHRQ Publications Clearinghouse, by writing to P.O. Box 8547, Silver Spring, MD 20907, by calling 1-800-358-9295, or on the Vidyya service at http://www.vidyya.com/0259_3.htm. The summary also is available from the National Guideline Clearinghouse (NGC) at www.guideline.gov (select NGC Resources). The full report of the EPC should be available in late spring.