Study Examines Presence of Uterine Cancers at Time of Morcellated Hysterectomy

Among women undergoing a minimally invasive hysterectomy using power morcellation, undetected uterine cancers were present in 27 per 10,000 women at the time of the procedure, according to a study published by JAMA. There has been concern that this procedure, in which the uterus is fragmented into smaller pieces, may result in the spread of undetected malignancies.

Despite the commercial availability of electric morcellators for two decades, accurate estimates of the prevalence of malignancy at the time of electric morcellation (or morcellation) have been lacking, according to background information in the JAMA article.

Jason D. Wright, MD, assistant professor of women’s health (in obstetrics and gynecology) at Columbia University Medical Center, and colleagues used a large insurance database to investigate the prevalence of underlying cancer in women who underwent uterine morcellation. The database includes more than 500 hospitals, capturing 15 percent of hospitalizations.

The researchers identified 232,882 women who underwent minimally invasive hysterectomy from 2006–12; morcellation was performed in 36,470 (15.7 percent) of them. Among those who underwent morcellation, 99 cases of uterine cancer were identified at the time of the procedure, a prevalence of 27/10,000. Other malignancies and precancerous abnormalities were also detected. Among women who underwent morcellation, advanced age was associated with underlying cancer, as well as endometrial hyperplasia (a condition characterized by overgrowth of the uterus lining).

The paper's authors write,

Although morcellators have been in use since 1993, few studies have described the prevalence of unexpected pathology at the time of hysterectomy. Prevalence information is the first step in determining the risk of spreading cancer with morcellation. . . . Patients considering morcellation should be adequately counseled about the prevalence of cancerous and precancerous conditions prior to undergoing the procedure.

This article is an edited version of a JAMA Network news release.