Black Women With Fibroids Have Greater Cancer Risk

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Researchers found that the association between a history of uterine leiomyoma—or fibroids—and cancer was strongest for cancer diagnosed within two years of uterine fibroids being found. The results could be explained by greater surveillance of women with fibroids or misdiagnosis of cancer as uterine leiomyoma.

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Relief for depression: the key may be individualized help
By Alicia Armeli

Relief_for_depression

With increasing demands at work, family responsibilities, and the expectation of what having it all should look like, statistics show depression affects women at a rate higher than men in every age group.1 Although labeled as one of the most common mental disorders in the US,2 it manifests differently for each person. And it’s because of this individuality that creating a treatment plan based on specific needs may be the key to finding relief.

Depression can show up in a number of ways that include both mental and physical symptoms. From feelings of hopelessness and anxiety to disturbed sleeping and eating patterns, when you’re depressed, you just don’t feel like you.

“Think of being depressed in a literal way—as actually being pressed down into a smaller, uncomfortable, more limited version of yourself. Depression is about not being able to shake that feeling,” explains Katherine Schafler, New York City-based emotional health expert and in-house licensed psychotherapist at Google. “One major criterion of depression is experiencing that pressed down feeling for most of the day, nearly every day in a two-week time period—that’s not the only criterion for depression, but if you’re experiencing the constancy it might be time to seek professional help.”

Among the many options for women to choose from, Schafler points to psychotherapy—also called talk therapy—as being a big one. A woman can find a qualified therapist through doctor referral or by a convenient click of a button. Nationally accredited mental health organizations have made it possible to find qualified support through sponsored online therapist locators. By plugging in a zip code, online locators allow a woman to sift through local therapists’ profiles using specialty filters, thereby helping her receive proper diagnosis and treatment.

Medical therapy is another viable option. When used together with talk therapy, research has shown this combination to be the most effective treatment for depression—especially when it’s severe.1 “Anti-depressants can be extremely helpful and there are many to choose from,” says Schafler. “It’s normal to feel hesitant about exploring medication but becoming as informed as possible can reduce this anxiety significantly, as can finding a psychiatrist whose approach you feel good about.”

In recent years, an interest in exploring Traditional Chinese Medicine has grown—with the most familiar treatment method being acupuncture. Although more research is needed to support its efficacy, meta-analysis studies have shown depression patients to benefit more from acupuncture combined with antidepressants versus the use of medication alone.3

Along with professional help, Schafler encourages women to create daily self-care routines. Participating in healthy relationships, eating nutritious foods, moving your body, and continuously doing what you enjoy are essential. “Adults need play, too,” she emphasizes. “Do something fun, sing in the car, dance, ride a bike, draw—what makes something feel playful is highly individualized, so only you can really know what play feels like for you.”

There are many more treatment options to help overcome depression and experimenting with what works (and what doesn’t) can take a lot of trial and error. A World Health Organization (WHO) World Mental Health Survey4 revealed that people commonly hold back from starting or continuing treatment because of a “perceived ineffectiveness of treatment” or “negative experiences with a treatment provider.” From talk therapy to self-care and beyond—trying different things under the guidance of a mental health professional you feel comfortable with is a significant part of recovery.

“Maybe the efficacy is in the treatment itself, but there’s also something healing in the gesture of trying,” notes Schafler. “For example, if you want to try acupuncture and it helps you to feel better, that’s fabulous, but even if it doesn’t help directly, the fact that you tried will bode well for you in the bigger picture. When you reach for something restorative and make choices based on self-progression instead of self-destruction, you communicate the following to yourself: ‘I’m worth it. I deserve to be happy. I deserve to feel good.’ And you do.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.

ABOUT THE THERAPIST Katherine Schafler (link www.katherineschafler.com) is an NYC-based emotional health expert; she splits her time between running her private psychotherapy practice and being an in-house therapist at Google. With dual master’s degrees in clinical assessment and psychological counseling from Columbia University and post-graduate training and certification from the Association for Spirituality and Psychotherapy in New York, NY, Katherine helps women change their lives for the better by learning how to—not just survive—but thrive. With twelve years of counseling experience in a broad range of capacities, Katherine tailors her approach to the unique needs of each of her clients.

REFERENCES

1.Pratt, L. A., & Brody, D. J. (2014). Depression in the U.S. Household Population, 2009-2012. Retrieved March 8, 2016, from http://www.cdc.gov/nchs/data/databriefs/db172.htm
2.U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2015). Depression (NIH Publication No. 15-3561). Bethesda, MD: U.S. Government Printing Office. Retrieved March 9, 2016 from http://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know-12-2015/index.shtml
3.Chan, Y. Y., Lo, W. Y., Yang, S. N., Chen, Y. H., & Lin, J. G. (2015). The benefit of combined acupuncture and antidepressant medication for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 176: 106-117. doi: 10.1016/j.jad.2015.01.048
4.Andrade, L. H., et. al. (2014). Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychological Medicine, 44(6): 1303-1317. doi: 10.1017/S003329171300194

Depression may increase uterine fibroid risk in African American women
By Alicia Armeli

Depression_may_increase

Uterine fibroids are more common and more severe among African American women. In an effort to uncover the cause of this health disparity, researchers are now investigating how mental health conditions like depression may play a role in the growth and development of fibroids.

In a recent study published in the American Journal of Obstetrics and Gynecology1, L. A. Wise and a team of researchers from Boston University analyzed the medical data of 15,963 premenopausal women participating in the Black Women’s Health Study.

In 1999 and 2005, the researchers used questionnaires that included the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms among these women. Between the years of 1999 and 2011, women completed follow-up biennial surveys reporting if they’d been diagnosed with depression, had any history of antidepressant use, and whether they’d been diagnosed with uterine fibroids by either ultrasound or surgery.

In all, 4,722 cases of diagnosed uterine fibroids were reported. Among these women, the authors of the study discovered that as the risk of depressive symptoms increased so did the risk of fibroids—even after the use of antidepressants was taken into account.

Wise and colleagues believe this connection between depression and fibroids is due to something they refer to as the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is an internal communication system made up of the hypothalamus and pituitary gland inside the brain and the adrenal glands that sit on top of the kidneys. Among its many functions, the HPA axis is responsible for regulating emotions and stress responses.

If the HPA axis malfunctions, it heightens the body’s stress response and can lead to changes in mood. HPA axis abnormalities have been linked to mood disorders like depression. This change can then alter how the body processes hormones—including sex hormones that are thought to influence fibroid growth. For example, levels of progesterone—a fibroid-stimulating hormone—are higher in women who are depressed than in those who aren’t.

The HPA axis theory is one of the many that are being explored in hopes of finding a cause and cure for fibroids. Although the results of this study support this theory, how depression and fibroids are possibly linked is still unclear. The authors concluded that further studies are still needed.

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.

REFERENCES

1. Wise, L. A., Li, S., Palmer, J. R., & Rosenberg, L. (2015). Depressive symptoms and risk of uterine leiomyomata. American Journal of Obstetrics and Gynecology, 212:617. e1-10.

Hysterectomy Alternatives Often Underutilized Leaving Women With Unnecessary Surgery as Only Option
By Alicia Armeli

In the US alone, more than 400,000 hysterectomies are performed each year, with 68 percent of these done to treat noncancerous conditions. The American Congress of Obstetricians and Gynecologists (ACOG) supports the use of alternatives to hysterectomy to treat non-life threatening gynecologic conditions. Yet, a recent study published in the American Journal of Obstetrics and Gynecology1 showed that these guidelines aren’t always followed and, as a result, women are undergoing unnecessary surgery.

Over a ten-month period in 2013, a team of researchers led by L. E. Corona analyzed the medical charts of women from 52 Michigan-based hospitals participating in the Michigan Surgical Quality Collaborative. Their goal was to investigate whether alternative treatments are offered to women with benign gynecologic diseases—such as fibroids, abnormal uterine bleeding, endometriosis, and pelvic pain—before proceeding to hysterectomy. Alternative treatments can include medical therapy such as pain management and levonorgestrel intrauterine devices or minimally invasive procedures like endometrial ablation and hysteroscopy.

Overall 3397 women underwent hysterectomy for benign conditions and results showed that among this group of women, nearly 40 percent didn’t have documentation of receiving any alternative treatments before surgery.

Of those who were provided with alternative treatments, 24 percent underwent minor procedures alone, while 18 percent were given medical therapy only. What’s more, the majority of women had been given no more than one documented therapy. The authors noted, “more than one therapy may have resulted in adequate treatment without the need for hysterectomy.”

Other factors such as age played a role in whether women received womb-sparing treatments. Sixty-eight percent of women younger than 40 years of age received alternative treatments in comparison to 62 percent of those 40-50 years old and 56 percent of women 50 years and older.

The end of the study revealed another key finding. Was hysterectomy appropriate for each woman?

Pathological reports following surgery showed that 18.3 percent of women did not have a supportive need for hysterectomy. When broken down by age groups, unsupportive hysterectomy was highest among women younger than 40 years of age. More than one-third of women (37.8%) under 40 had unsupportive hysterectomies versus those 40-50 years of age (12%) and over 50 years (7.5%).

This rate of unsupportive surgery, the authors contend, reflects the likelihood that a significant number of women who undergo hysterectomy for reasons like abnormal uterine bleeding are doing so for reasons inconsistent with ACOG guidelines that recommend medical therapy before surgery.

Although the number of hysterectomies performed in the US has reportedly declined, the appropriateness of hysterectomy is still an area of concern, the authors stressed. “The fact that 18 percent of women did not have pathology supportive of the need for hysterectomy and that the majority of women consider at most one alternative treatment prior to hysterectomy indicates that there are opportunities to decrease the utilization of hysterectomy.”

REFERENCES

1. Corona, L.E., Swenson, C.W., Sheetz, K.H., et al. Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. American Journal of Obstetrics and Gynecology, 212: 304e1-7.

Shelaagh Ferrell: A fight for UFE
By Alicia Armeli

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Having trained as a dancer, Shelaagh Ferrell knew her body inside out.
“It seemed as if I was developing muscle on one side of my abdomen and not the other,” explained Shelaagh. “I went to my doctor and said, ‘It’s really strange. Why do I have overdeveloped muscles on my right side of my abdomen and not on my left?’”

It was then that Shelaagh was diagnosed with fibroids—common benign tumors that grow from smooth muscle tissue of the uterus. “That was really the first time I had even heard the word fibroid,” she admitted.

Uterine fibroids are commonly associated with symptoms such as heavy painful periods, but Shelaagh’s case was different. Not having the usual symptoms, she had what physicians refer to as asymptomatic fibroids. “I wasn’t feeling any pain. I wasn’t experiencing heavy bleeding, as many women do with fibroids.”

But her fibroids were problematic in other ways. “As the fibroids grew, it was clear I was starting to look rather pregnant,” she described. And for Shelaagh, body image is important. With a lean physique of a former dancer and with her work as an actress, singer, film producer and writer, she takes obvious pride in this facet of her femininity.

“The other symptom was that I really started to feel tired. Exceedingly tired,” Shelaagh continued. “Doctors thought perhaps it was because I was doing a lot, but I knew it wasn’t.”

With a large fibroid the size of an avocado, Shelaagh was given four options: a hysterectomy, a myomectomy, uterine fibroid embolization (UFE), or to watch and wait.

Like many other women, she found herself stuck between a rock and a hard place. At the time, she was unfamiliar with UFE. And describing herself as a person who will “avoid surgery at all costs”—going under the knife was not a viable choice. And so, she decided to continue to monitor her fibroid growth.

“I was told the [UFE procedure] would be really painful,” Shelaagh explained. “I worried about a benign tumor dying inside of me and wondered how bad that would be. So I thought it was probably best to do nothing.”

Six years after her diagnosis, she continued to watch and wait. During this time, her fibroid grew to 20 centimeters and began pressing on her inferior vena cava, a major vessel that carries blood from the lower body to the heart. Something had to be done.

After diligently researching UFE, Shelaagh decided it was the right fibroid treatment for her. “I was adamant. I didn’t want a hysterectomy,” she stressed. “I didn’t even want a myomectomy.”

Against the wishes of many general practitioners, she continued to fight for her body. “Of course you want to keep your womb,” Shelaagh recalled passionately. “The first instinct of most general practitioners is to say, ‘We’ll put you in for a hysterectomy. Why do you want to keep your womb? You don’t need a womb at your age.’ That’s very upsetting. It’s very insulting.”

With her mind made up, she searched for an interventional radiologist to ask if she could be a candidate for UFE. “I was very lucky. I had Dr. Cheryl Hoffman from UCLA. She was so supportive. She was so impressed that I had fought for UFE.”

With Dr. Hoffman, Shelaagh finally got the relief she fought so hard for. Using words like “comfortable” and “not painful” to describe the approximately hour-long UFE procedure, she was pleased with her experience. Only having “a little ache” for a week afterwards—she was able to start dancing again within two to three weeks.

“The result for me is I don’t feel tired anymore. I feel younger than I was then. I have far more energy…[and] a flatter looking tummy,” she said. “It’s been just over a year now. My fibroid is still there but it is a lot smaller and lighter.”

Back on the dance floor, able to move the body she knows so well and fought so hard to protect, Shelaagh avidly encourages women everywhere to “ask for UFE.”

Treating Fibroids from the Wrist

Transradial access is proving to be beneficial for treating conditions beyond the heart

By Alicia Armeli

For over 20 years, interventional radiologists have performed uterine fibroid embolization (UFE), providing women a nonsurgical option to treat their fibroids. Recently, some of these doctors have started taking a different approach to this decades-old procedure. Instead of accessing fibroids through the groin, patients are offered a safe and effective alternative—the wrist. A growing number of interventional radiologists report that this technique has improved patient care and comfort both during the UFE procedure and recovery.

Uterine fibroids affect up to 40 percent of women 35 years of age and older1 and
Femoralaccess-340x281can cause symptoms such as heavy painful periods, pelvic pressure, painful intercourse, and urinary incontinence. But in order to treat these noncancerous growths, interventional radiologists have to reach them first.

FemoralaccessTraditionally, the femoral artery in the groin has been the go-to access site when performing UFE. Making a small incision in the skin, an interventional radiologist threads a thin catheter through the femoral artery into the uterine arteries that feed blood to the fibroids. Tiny particles are injected into the uterine arteries, blocking blood flow to the fibroids, causing them to significantly shrink and scar down into the surrounding tissues. Studies show that UFE can offer an approximate 90 percent cure rate.2

With a continuous drive to improve UFE, interventional radiologists have now found they can just as easily access fibroids using the radial artery in the wrist.UFE_History
This approach, formally known as percutaneous transradial access, was first used in 1989 to perform a coronary angiography (a test that uses dye and special x-rays to show the arteries supplying blood to a patient’s heart). Today, in some parts of the world, transradial access is used for 80 percent or more of interventional coronary procedures.3

“Transradial access provides many benefits for patients,” said Dr. Neil Resnick, Chief of the Division of Interventional Radiology at NYC Health + Hospitals/Harlem, and Assistant Clinical Professor of Radiology at Columbia University Medical Center in New York. “My UFE patients may assume the most comfortable positions during recovery without worrying about major bleeding complications if they bend at their hip. They may sit up right away and are able to move around much earlier. Issues related to patient modesty, religious preferences, and groin sensitivity are minimized.”

These advantages reflect the results of large multicenter studies that have revealed more than 90 percent of patients who have experienced both transfemoral and transradial access for cardiovascular care would choose transradial if they had to undergo another procedure.4

Initially, data on transradial safety and efficacy were mainly limited to interventional cardiology studies. But the many benefits of the transradial approach are transferrable to procedures that treat conditions beyond the heart—and research is emerging to support this.

“Cardiologists have studied thousands of these procedures, which have been shown to be safer compared with their traditional transfemoral counterparts,” Dr. Resnick explained. “Transradial access is presumably safer still during interventional radiology procedures, especially UFE, given that these patients tend to have significantly less cardiovascular disease and aren’t routinely given high doses of blood thinning medications.”

A 2016 clinical study published in the Journal of Vascular and Interventional Radiology5 followed the recovery of over 900 patients who underwent more than 1500 transradial access interventional procedures—UFE being one such procedure. Fischman and a team of experts at Icahn School of Medicine at Mount Sinai evaluated patient progress after 30 days and found transradial access to have a success rate of greater than 98 percent with virtually negligible complications reported.

These results mirrored those seen in a smaller study where success rates reached 100 percent with no immediate major or minor complications.6/

However, just as with any medical procedure—albeit minimal—transradial access does have its risks. According to Dr. Resnick, the more common risks include slight bruising at the puncture site, inflammation of the radial artery, arterial spasm, and, very rarely, silent arterial blockage.

“Major complications involving significant bleeding or injury to the radial artery requiring repair are exceedingly rare events,” he added. “Any risk to the fingers is minimized when [specific tests] are performed ahead of time.” Stroke is another risk associated with transradial access, but “to date, there are no published reports of stroke caused by transradial interventional radiology procedures.”

Most importantly, patients now have options when it comes to choosing an access site for UFE—transfemoral or transradial. This can be especially important for women with fibroids. “Over the years I’ve received a number of calls from patients who sought to reschedule their UFE on account of having their period at the time they are to undergo the procedure,” Dr. Resnick explained. “My transradial patients are quite pleased when I remind them that I won’t be working from the groin and we may proceed as scheduled.”

For patients who have chosen UFE through their wrist, Dr. Resnick said the reviews have been positive. “Patients are amazed by transradial access, and they love it.” This technique is becoming increasingly available to patients, reported Dr. Resnick. “There will always be resistance to change among physicians who have been performing a procedure the same way for many years. However, I’m seeing more and more interventional radiologists undertake transradial access once they learn of its many benefits.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.

ABOUT THE DOCTOR Neil J. Resnick MD is Chief of the Division of Interventional Radiology at NYC Health + Hospitals/Harlem, and Assistant Clinical Professor of Radiology at Columbia University Medical Center in New York. Through his research and diverse experience in Interventional and Diagnostic Radiology, Dr. Resnick strives to improve the field of Interventional Radiology with the goal of providing patients with the best care possible.

REFERENCES

1. Society of Interventional Radiology. (2016). Uterine Fibroid Symptoms, Diagnosis and Treatment. Retrieved February 9, 2016, from http://www.sirweb.org/patients/uterine-fibroids/
2. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.

3. Global Radial Adoption. Taken from https://thinkradial.com/for-patients/the-basics

4. Jolly S.S., Amlani S., Hamon M., Yusuf S., Mehta S.R. (2009) Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and metanalysis of randomized trials. American Heart Journal. 157:132-140.

5. Posham, R., Biederman, D. M., Patel, R. S., Kim, E., Tabori, N. E., Nowakowski, F. S., Lookstein, R. A., Fischman, A. M. (2016). Transradial approach for noncoronary interventions: a single-center review of safety and feasibility in the first 1500 cases. Journal of Vascular and Interventional Radiology, 27(2): 159-166. doi: 10.1016/j.jvir.2015.10.026

6. Resnick, N. J., Kim, E., Patel, R. S., Lookstein, R. A., Nowakowski, F. S., &Fischman, A. M. (2014). Uterine artery embolization using a transradial approach: initial experience and technique. Journal of Vascular and Interventional Radiology, 25: 443-447. doi:http://dx.doi.org/10.1016/j.jvir.2013.11.010

UFE: An Internet-Driven Treatment Option
By Alicia Armeli

UFE_History

Uterine fibroid embolization (UFE)—also known as uterine artery embolization (UAE)—is one of many fibroid treatment options available to women. However, unlike other fibroid therapies and procedures, studies show UFE’s growing popularity may not come from doctor referral but instead from an entirely different source—the Internet.

Although UFE was first used to ease heavy bleeding after childbirth,1 it wasn’t until the mid 1970s that it was also seen to alleviate symptoms associated with fibroids.

Nearly two decades later, UFE was analyzed for its safety and effectiveness in fibroid treatment. In the early stages, it was seen to have a 70 percent success rate.2 Today UFE has been found to be 90 percent<sup”>3 effective in treating fibroid-related symptoms like heavy painful periods, urinary incontinence, pelvic pressure, and painful intercourse.

Despite these findings, approximately 600,000 hysterectomies are performed annually in the US alone4—many of which are done to treat benign conditions like fibroids. And according to research, these numbers may reflect a lag in patient knowledge regarding minimally invasive treatment options, like UFE. Women have reported their doctors recommending hysterectomy but no other alternatives, prompting them to learn about UFE in other ways.

“[Uterine fibroid embolization] development has been largely driven by patients seeking a less invasive alternative to hysterectomy,” wrote Dr. James Spies, MD MPH and Dr. Jean-Pierre Pelage, MD PHD, authors of the book Uterine Artery Embolization and Gynecologic Embolotherapy.5 This revolutionary movement, they continued, could be largely attributed to the development of the Internet, which allows patients to explore more treatment options available to them.

With the push of a button, women can now explore the web for fibroid information, locate interventional radiologists who perform UFE, and find strength among thousands of other women who belong to online fibroid support groups.

However, this endless information comes with a catch. Ease of accessibility doesn’t always guarantee reliability. Using the keywords “uterine artery embolization,” a team of experts led by A. N. Tavare of the British Medical Journal Publishing Group, British Medical Association House in London, UK investigated the top 50 results from three major search engines. The results published in CardioVasular and Interventional Radiology6 revealed that although these sites scored high in the categories of accessibility and user-friendliness at 80 percent and 77 percent respectively, they were only 39 percent reliable.

The main problem? The authors found that the information published online often didn’t have any evidence cited to support it. The authors noted that as women search online for answers, it’s important they seek websites that contain researched information when making decisions about their fibroid care.

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.

REFERENCES

Uterine Fibroids: Treating fibroids non-invasively. (2015). Uterine Artery Embolization (UAE). Retrieved October 30, 2015, from http://www.uterine-fibroids.org/uae.html
Gonsalves, C. (2008). Uterine artery embolization for treatment of symptomatic fibroids. Seminars in Interventional Radiology, 25(4): 369-377. doi: 10.1055/s-0028-1103001
McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.
Centers for Disease Control and Prevention. (2016). Hysterectomy in the United States, 2000-2004. Retrieved February 19, 2016, from
http://www.cdc.gov/reproductivehealth/data_stats/
Spies, J. B., & Pelage, J. (2005). Uterine artery embolization and gynecologic embolotherapy (1st ed.). Baltimore, MD: Lippincott Williams & Wilkins.
Tavare, A. N., Alsafi, A., & Hamady, M. S. (2012). Analysis of the quality of information obtained about uterine artery embolization for the Internet. CardioVascular and Interventional Radiology, 35(6): 1355-1362.

There’s No ‘I’ in Team: Research Shows Gynecologist and Interventional Radiologist Collaboration is Best for Fibroid Care
By Alicia Armeli

mummy

Although the roles of gynecologist and interventional radiologist seem like two unrelated specialties when treating uterine fibroids, researchers have found the opposite to be true. Working together as a team has resulted in a win-win situation for doctors—and most importantly—for patients.

“One of the challenges if you’re a specialist in gynecology or radiology is that you really only have one tool,” said Dr. Christopher Tarnay, Clinical Professor of Obstetrics & Gynecology and Urology at UCLA School of Medicine, Chief of the Division of Female Pelvic Medicine and Reconstructive Surgery, and Co-Director of the Comprehensive Fibroid Treatment Program at UCLA in Los Angeles, Calif. “You tend to only offer the tools you have available to that patient. If you’re a gynecologist, you have medications or surgery. If you’re an interventional radiologist, you’ll offer the things you have in your tool belt like uterine fibroid embolization (UFE).”

Currently a reality of our healthcare system, this prevalent gap between specialties could be doing patients more harm than good. Without full disclosure of all fibroid treatment options, a woman may potentially undergo a procedure that doesn’t align with what she wants or needs.

“Patients are increasingly opting for less invasive therapies compared to the past, when hysterectomy was considered the mainstay of treatment,” said Dr. Neil Resnick, Chief of the Division of Interventional Radiology at NYC Health + Hospitals/Harlem and Assistant Clinical Professor of Radiology at Columbia University Medical Center in New York City. “Patients see tremendous benefits when gynecologists and radiologists collaborate strongly. All patients requiring invasive fibroid treatment are evaluated by both specialties at my institution. Our patients may choose from the entire spectrum of anti-fibroid therapies. We have found that comprehensive care is optimal for addressing women’s health needs.”

But this collaboration hasn’t always come easy. Gynecologists may disagree with practicing in a collaborative manner for fear of losing patients—instead the opposite has been observed. “My colleagues found over time they did not lose all of their patients,” Dr. Resnick discussed referencing his institution’s collaborative environment. “And [patients] who returned to them after UFE were very satisfied with the results and pleased with the referral they made.”

To investigate how a cooperative referral relationship affected patient and doctor experience, a team of experts led by R. K. Zurawin at Baylor College of Medicine in Houston, Texas, tracked the course of fibroid treatment among 226 women. Of these women, 138 were referred to an interventional radiologist by a gynecologist and 88 were self-referred.

The results, published in the Journal of Minimally Invasive Gynecology1, revealed that 62 percent of the women were candidates for UFE and 38 percent had the procedure done during the study. Those who didn’t undergo UFE returned to the referring gynecologist for further care.

In terms of patient satisfaction—whether women underwent UFE or another treatment—70 percent of those self-referred and 92 percent of those gynecologist-referred reported being satisfied with their original gynecologist and were referred back to their doctor.

A reported 8 percent of gynecologist-referred women were dissatisfied and switched to another doctor mainly because of “the gynecologist’s failure to fully disclose treatment options or offer desired minimally invasive procedures.”

From a business perspective, collaboration with an interventional radiologist was seen to improve “patient flow to a gynecologist practice.” Including self-referred women who were sent to in-network gynecologists as new patients, researchers saw a 119 percent return rate on the original 138 women referred to a radiologist by their gynecologist.

It was concluded that establishing a “trusting, collaborative, long-term, noncompetitive” relationship between specialties not only expanded business but also was seen to meet patient needs for full disclosure of all treatment options and improve overall care.

A significant part of developing this noncompetitive relationship between doctors is recognizing the limits of each specialty and respecting these boundaries. “Gynecologists and radiologists each have different strengths to bring to the table for women with symptomatic fibroids,” Dr. Resnick emphasized.

“Interventional radiologists play an important role,” Dr. Tarnay agreed. “But a patient who has a fibroid really needs to first see a gynecologist who can offer a pelvic exam and evaluate all symptoms. This was the nidus for developing a comprehensive program at UCLA. The more you can collaborate and learn about other options—the better.” In Dr. Tarnay’s research published in the Journal of Therapeutic Ultrasound2, an integrated approach at his facility was shown to increase the use of less invasive options over hysterectomy. “Our study supports the feasibility of a combined approach and likely facilitates the increased use of less invasive options over hysterectomy for fibroid treatment.”

With so many treatment options available, how can a woman with fibroids ensure she’s receiving comprehensive care?

Both doctors commented on the importance of working with specialists who candidly pool together their knowledge and expertise. This openness can provide a clearer picture of a woman’s condition and how to effectively treat it. If this isn’t a woman’s experience, she should feel secure in her choice to look elsewhere.

“A patient should feel free to seek out a gynecologist who is collaborative about patient care and understands the value of UFE,” Dr. Resnick stressed. “Alternatively, she may set up an appointment directly to see an interventional radiologist to discuss if she may be an appropriate candidate for the procedure. However, it is highly valuable and, in fact, necessary that she also be evaluated by a gynecologist, who can ensure her care is complete.”

“Explaining all of the information with balance is the intent of collaboration,” Dr. Tarnay explained. “Ultimately, it’s about putting the patient’s best interests first.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.

ABOUT THE DOCTOR Christopher Tarnay is a Clinical Professor of Obstetrics & Gynecology and Urology at UCLA School of Medicine, Chief of the Division of Female Pelvic Medicine and Reconstructive Surgery, and Co-Director of the Comprehensive Fibroid Treatment Program at UCLA. Dr. Tarnay incorporates the latest advances in minimally invasive surgery emphasizing the importance of uterine and fertility preservation. Named a Super Doctor of Southern California Los Angeles, Dr. Tarnay is American Board Certified in Obstetrics & Gynecology and Female Pelvic Medicine and Reconstructive Surgery.

ABOUT THE DOCTOR Neil J. Resnick is Chief of the Division of Interventional Radiology at NYC Health + Hospitals/Harlem and Assistant Clinical Professor of Radiology at Columbia University Medical Center in New York City. Through his research and diverse experience in Interventional and Diagnostic Radiology, Dr. Resnick strives to improve the field of Interventional Radiology with the goal of providing patients with the best care possible.

REFERENCES

Zurawin, R. K., Fischer, J. H., & Amir, L. (2010). The effect of a gynecologist-interventional radiologist relationship on selection of treatment modality for the patient with uterine myoma. Journal of Minimally Invasive Gynecology, 17(2):214-221. doi: 10.1016/j.jmig.2009.12.015
2. Tan, N., McClure, T. D., Tarnay, C., Johnson, M.T., Lu, D.S., & Raman, S.S. (2014). Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center. Journal of Therapeutic Ultrasound, 15(2):3. doi: 10.1186/2050-5736-2-3