Surgical treatment can harm women, doctors say

Can spread cancer during hysterectomies

A Boston surgeon and his wife, an anesthesiologist, are pushing to stop a widespread surgical technique used on thousands of women during hysterectomies, which they say caused her undetected cancer to dangerously spread.

Dr. Hooman Noorchashm, a cardiothoracic surgeon at Brigham and Women’s Hospital, has started an online petition and written dozens of letters to medical journals and news organizations charging that the technique, called “morcellation,’’ is endangering women and creating a public health crisis.

He has adamantly demanded that his own hospital, where his wife’s operation occurred, stop using the procedure and called on other hospitals and doctors nationwide to do likewise. It is employed during laparoscopic hysterectomies, a type of minimally invasive surgery.

“This is a very ethically black-and-white issue,’’ Noorchashm said. “One of your own got it. Stop doing it at the Brigham at least and encourage others to stop doing it.’

The hospital has made some changes, including recommending against morcellation for certain women who are more likely to have undetected cancer, but will continue to use the procedure.

Leaders at the Brigham and a number of other organizations nationally said that the risk of spreading cancer is low and that in many cases, particularly for younger women, it is outweighed by the benefits of removing the uterus laparoscopically. But some are starting to raise cautions.

Noorchashm began campaigning against the procedure after his wife, Dr. Amy Reed, a physician at Beth Israel Deaconess Medical Center, got a cancer diagnosis.

Reed, 40, underwent a hysterectomy in October at the Brigham to treat what she was told were probably benign fibroids, or masses, in her uterus. During the laparoscopic procedure, the gynecologist used a morcellator to cut her uterus and the fibroids inside into small pieces so they could be taken out through the tiny incisions used in minimally invasive surgery.

Follow-up tests found that Reed had uterine leiomyosarcoma, a rare, aggressive cancer. Later imaging tests showed that the cancerous tissue had been spread through her abdominal cavity during the surgery, giving her stage 4 cancer, her husband said. He said she also has nodules on her lung, which doctors are watching and are unsure if they are cancer.

The couple has six children between the ages of 1 and 12.

Reed is undergoing chemotherapy and is recovering from major follow-up surgery at another hospital to remove cancerous tissue. She said Tuesday that she is lucky to “have a lot of family support’’ but “it’s been incredibly difficult for all of us.”

“There is no reason women should be going through this,’’ she said.

Reed said the gynecologist at the Brigham who did her hysterectomy did not inform her of the risk that morcellation can spread cancer. The hospital agreed with this characterization, though it said the doctor did disclose a remote risk of the fibroids being cancerous.

The Brigham, which uses morcellation in about 200 gynecological surgeries a year, said it will not stop using the procedure because it is the standard of practice, as recommended by national physician groups.

The Brigham did issue formal guidelines to doctors this month on when morcellation should and should not be used and on informed consent for patients, based on Reed’s case and that of another woman whose uterine cancer was spread by morcellation, both of which occurred in the last 14 months. The hospital reccomends against the procedure in women with any evidence of cancer or in women over 45 who have large uterine masses and heavy menstrual bleeding, who might be more likely to have hidden cancer.

In a letter sent to medical staff on Dec. 5, Dr. Robert Barbieri, obstetrics and gynecology chairman, urged doctors to talk with patients about the small risk of spreading cancer through morcellation, which he said may occur in as many as 1 in 400 cases. “We reiterated this is something we are keeping an eye on,’’ he said. “We want doctors to be explicit.”

The Brigham said in a statement that “while it’s not possible to know what impact the procedure will ultimately have on Dr. Reed’s health, we do know that literature suggests morcellation of malignant tumors increases the chances of mortality.”

“All involved in Dr. Reed’s care are deeply saddened by the news of her illness,’’ it said.

About 600,000 hysterectomies are done in the United States every year, most to treat benign fibroids using minimally invasive techniques. Morcellation is not generally recommended for use in patients who are known to have cancer. But there is no definitive diagnostic test for leiomyosarcoma.

Such sarcomas have a high rate of recurrence even in woman who have not undergone a morcellation, said Dr. Barbara Goff of the University of Washington, president of the Society of Gynecologic Oncology. Morcellation allows many women to have safer hysterectomies with better outcomes than full abdominal surgery.

But Dr. Bobbie Gostout, chairwoman of obstetrics and gynecology at the Mayo Clinic, said more women should be given the option of a vaginal hysterectomy, especially because morcellation “is a questionable practice.”