By Jon Kamp
The country's leading medical organization for gynecologists on
Friday defended a controversial surgical technique, the second
professional society to support the procedure this week amid
concerns that it can spread a rare but deadly cancer.
The American College of Obstetricians and Gynecologists
acknowledged that power morcellators--used to remove common uterine
growths called fibroids, sometimes in hysterectomies--can spread
undetected cancer and worsen a woman's prognosis. But the group
said the risk is difficult to measure because the cancer is rare
and the data limited.
The medical society said the cancer hazard must be balanced
against the benefits of minimally invasive surgery, which often
involves morcellators. The devices are used to slice tissue into
smaller pieces so they can be removed through tiny abdominal
incisions. ACOG is an influential group with 58,000 members. Its
guidance can carry weight with doctors, hospitals and health
insurers as they set treatment policies.
The group's recommendations are similar to guidelines issued
Thursday by the gynecologist trade group AAGL, formerly known as
the American Association of Gynecologic Laparoscopists. The AAGL
discouraged gynecologists from performing morcellation on
postmenopausal women, who have an elevated risk of this cancer.
ACOG said age and menopausal status are risk factors doctors should
heed.
The latest position offered more fodder for a continuing debate
about the medical practice, which came under fire recently
following a high-profile case of morcellator-related cancer in
Boston.
It also put ACOG somewhat at odds with the U.S. Food and Drug
Administration, which last month advised doctors to stop using
morcellators, saying the risk of hidden cancer was 1 in 350 for
women undergoing surgery to remove fibroids. The agency plans to
examine the issue further in a meeting this summer. The move
prompted several hospitals to halt the surgery and Johnson &
Johnson, by far the largest manufacturer, to suspend global sales
last week.
ACOG put the cancer risk at about 1 in 500, and said women
should be advised of that estimate, but said more research is
needed. A traditional hysterectomy with a long abdominal incision
carries risks including bleeding and infections, and three times
the risk of death, ACOG said.
"It's critical that we not severely restrict treatment options
for women who would benefit from minimally invasive gynecologic
surgery while minimizing the risk for the small number of women who
may have an occult or hidden cancer," ACOG Chief Executive Hal C.
Lawrence III said.
He said there are other less-invasive alternatives to open
surgery, but they won't work for all women, he said.
The organization said doctors shouldn't use morcellators in
cases where women have known or strongly suspected cancers,
although the cancer at issue can't be definitively detected before
surgery. It said doctors should advise patients of risks and
alternatives.
Write to Jon Kamp at jon.kamp@wsj.com
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