Jennifer Levits reported in the Wall Street Journal 12/18/13 “Doctors Eye Cancer Risk in Uterine Procedure“. She recounted the story of Dr. Amy Reed who had a hysterectomy. The uterus contained fibroids and the fibroids contained cancer. The procedure was done with an instrument, the morcelator. In kitchen terms it is a combination blender and vacuum cleaner. It is used during laproscopic surgery to chop up things (like a uterus with fibroids) and remove them through a small incision in the abdomen.
The problem is the morcelator does not remove all the tissue. A few cells escape the vacuum and they are left behind in the abdomen. If those cells contain cancer the cancer is then planted in the abdomen later to grow and likely kill the patient. Dr. Reed developed the seeding of cancer and claims other procedures would be better. Traditional surgery removes the uterus and fibroids intact with less chance of spreading any unsuspected cancer.
Here is what the package insert that comes with the morcelator says:
CAUTION: … use of the … Morcellator may lead to dissemination of malignant tissue.
So what are the statistics?
- 20% – 40% of women will develop fibroids
- 1 in 1000 cases of fibroids contain cancer
- intact removal of fibroids with malignancy failed to stop the malignancy 19% of the time
- morcelator removal of fibroids with malignancy failed to stop the malignancy 44% of the time
The big question is: should a morcelator be used if a woman has fibroids because it may double the risk of spreading an unsuspected cancer?
The simple answer is NO, because there are other surgical options. But, will women accept that answer? The laprosocopic procedure has less pain and quicker recovery, so the answer turns out not to be so simple. There are many forces at work on the decision to continue to use the morcelator. The analysis of these forces is called force-field analysis which was originally described by social scientist Kurt Lewin in the 1940’s. The following is such an analysis (the rating of force vectors is by the author of this blog):
So, what will happen? It seems at this point the morcelator will continue to be used. But, the risk remains. Law suits will continue. Perhaps a safer device will be developed. Perhaps a high risk of litigation will be perceived by gynecologists and the malpractice insurance companies as being too great. Such risk will lower the forces from doctors and perhaps tip the balance. Time will tell.
Update (8/1/14): since the original post the FDA issued a warning about morcelators. Yesterday, Johnson & Johnson, the major supplier, stopped selling morcelators. Looks like the forces to abandon the morcelator have been joined by the FDA and the manufacturer.
Update (2/27/15): yesterday the Wall Street Journal reported United Health (insurance) requires surgeons to obtain permission for procedures that might use the morcelator — “another blow” to the device. At this point any surgeon using the device must feel like they are walking a tightrope without a net.