Health Disparities in Uterine Fibroid Patients: a Q&A

Uterine fibroid tumors are more common and more severe in African American women compared with white women, a new study finds.

The study, conducted by a group of researchers for the Program in Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, has brought to light the fact that uterine fibroid tumors disproportionately affect the African American population. However, there is little known about why the disease is so much more severe in African American women.

A major indication for hysterectomy, uterine fibroid tumors pose a significant burden to the health care system and can negatively affect a patient’s quality of life and socioeconomic status. In general, these burdens are greater for African American women than for white women.

In a brief interview with ObGyn.net, study coauthor Elizabeth A. Stewart, MD, professor of obstetrics and gynecology and chair of the division of reproductive endocrinology at the Mayo Clinic and the Mayo Medical School in Rochester, Minn, shares some of her insight into these findings.

What was the major finding that surprised you the most? And the least?

I was surprised to see how the disparities of fibroids were compounded at every step for African American (AA) women. AA women have more severe fibroid symptoms and are more likely to experience symptoms longer before seeking treatment. Then, AA women find it harder to get good information about treatment options. Moreover, they have more concerns regarding treatment complications and outcomes.

I was least surprised about the importance AA women place on fertility and future pregnancy. Given the many historical limitations placed on the reproductive freedom of women of color, this is not surprising. Nevertheless, it emphasizes the importance of alternatives to hysterectomy for AA women.

What is the discrepancy, if known, between the expected rate of uterine fibroid tumors in African American women and the actual rate of uterine fibroid tumors diagnosed in African American women. And in white women as a comparison?

It doesn’t appear that there is significant underdiagnosis of fibroids for AA women. However, AA women do develop fibroids at an earlier age, have more severe disease, and don’t have the slowing of their fibroid growth as they approach menopause like white women do. The chance of fibroids developing is over 70% for white women and almost 80% for black women.

How does the typical treatment of uterine fibroid tumors diagnosed in white women differ from the typical treatment of those in African American women?

We really don’t know much about differences in treatment patterns except that AA women have higher rates for all types of fibroid treatments. Based on national data we published previously, black women are more than twice as likely to undergo a hysterectomy for fibroids, more than 3 times as likely to be hospitalized for fibroids, and more than 6 times as likely to have a myomectomy.

What role, if any, does health care coverage play in these differences?

That is not clear. We are currently doing a series of studies looking at treatment patterns for fibroids in women with commercial insurance. We hope to have these answers in the near future.

Is there anything that ob/gyns can do in their clinical practice to help eliminate these discrepancies?

I see two opportunities. First when caring for young women, being aware that AA women develop fibroids on average in their late 20s as opposed to their 30s for white women is important. An early diagnosis often means more minimally invasive treatment options are available.

Second, I think it’s important to present a full range of treatment options and to respect a woman’s desire to avoid hysterectomy even if she is not intending pregnancy.

How will the health care reform laws and insurance pools that are soon to be available influence how uterine fibroid tumors are diagnosed and treated in African American women?

This is not clear. However, it may allow more women to seek routine gynecological care and this may lead to increased diagnosis of fibroids at a stage where minimally invasive treatments are possible.

What is the most important fact or detail that you would like your ob/gyn colleagues to know about these study findings?

African American women were 77% more likely to miss work due to their fibroids than their white counterparts. This suggests that the economic costs of fibroids may be significantly underestimated, and it has implications for our colleagues as well as our patients.

References:

Eltoukhi HM, Modi MN, Weston M, et al. The health disparities of uterine fibroid tumors for African American women: a public health issue. Am J Obstet Gynecol. 2013 Aug 11. pii: S0002-9378(13)00834-X. doi: 10.1016/j.ajog.2013.08.008. [Epub ahead of print]