Monday, January 28, 2008

Women's Health, Fibroids and Liver Cancer: Embolization gets a new breather..marketwise speaking..Any other indications?

[Click on Post Title for Link to External Article]

Champagne bottles must be popping at BioSphere today. They have dipped into the Chinese market, thus proving what an advantage it could be for companies if they started selling in India or China.

They also saw an immediate spike on their stock price..

Moving on to Fibroid Embolization, I have always been curious about why this procedure did not take off more in the US. Of the 600,000 odd hysterectomies a year, about 40% are related to Fibroids directly or indirectly. That is about 240,000 procedures.

Comparitively speaking, there have been only a total of 50,000 (as of 2005) to about 75,000 (just my stretchy guess. don't quote me) UFE procedures worldwide!

I can probably think of a few good reasons:

* Would gynecologists be willing to place their patients in the hands of Interventional Radiologists?

* Gyn-Surgeons prefer to do hysterectomy, and there are some dubious studies that claim that hysterectomy is actually a good option. [Refer to the bottom of this post for an "interesting" example]

* Embolization of Uterine Fibroid Arteries has been around for about 10+ years now, and has festered in the absence of strong scientific publications or long term studies backing it. A few studies have taken place, but are by no means large enough to justify a shift in treatment standards.

* Embolization cannot be the best solution always, since fibroids occur in multiples usually and it is not possible to accurately pinpoint or embolize arteries feeding all fibroids.

* Arterial embolization requires, among other things, good visualization, and in cases where the Uterine Artery or one of its main branches has been harvested by the fibroid to vascularize, embolization cannot be an option.

Among my other worries, something I wish to find out is, what are the risks of the microspheres, bioresorbable or not, in terms of their ability to cause thrombus related cardiovascular problems elsewhere in the body? Though this is sparsely discussed, again, for the want of long term follow up, no statistical data is available.

Well anyway, it still seems like, outside the US, where the lines between the practice of Interventional Radiology and Gynecology may be thin, or owing to the fact that hysterectomies tend to be expensive, it is possible that the availability of microspheres could help increase the number of UFEs performed worldwide, thus allowing us to see some long term data emerge, painting a clear picture...

As to primary liver cancers and Embolization, a similar lack of data seems to be the basic problem, although very honestly, I have not spent a lot of time looking at the problem area. Comments are welcome!

The Dubious Hysterectomy Debate:

This study in particular makes me very uncomfortable.

We don't have effective therapies for fibroids or pelvic pain - reasons for which include the inability to accurately pinpoint etiology and origin of pain. There are several options for menorrhagia, the leading product being NovaSure.

This study claims that since people with fibroids, pelvic pain and (wrongfully so) abnormal (typically heavy) menstrual bleeding do not have many treatment options, and hence will undergo hysterectomies anyway - one should now consider undergoing a hysterectomy to avoid "years of pain".

This strategy is very dubious, and fails to account for emerging treatment strategies as they relate to menorrhagia and fibroids. I am not very clear on chronic pelvic pain, but I am hoping someone out there is trying something.

So, instead of shying away from hysterectomy and encouraging other treatment options, the study snidely suggests that women should just be offered hysterectomy as a preventive measure.

Somehow it is a very disconcerting point of view....

Add to Onlywire


Dusko Savic said...

Yes, indeed, the idea that everyone should have a hysterectomy as soon as possible, is totally wrong. The underlying reasoning goes like this:

We, the doctors, we have studied everything under the Sun (medicine if tough),

we learn everything there is under the Sun (our continual education costs soo much), therefore,

when we don't know how to heal the patient with uterine fibroids, it follows that no one else in the world can do anything about it.

So, you must have a hysterectomy. And if you want to do a final good unto yourself (the originators of the study say), have a hysterectomy as soon as you can. At $20,000 per hysterectomy, I bet surgeons all over the world rejoice at ideas such as this!

This so conveniently forgets that so many other women saved themselves from surgery simply by looking beyond the medical industry and siezing advantages of various fields of alternative healing.

If you have myoma, you can find your own solution through Reiki, homeopathy, Su Jok and many other energy healing techniques -- provided, you wake up and look through the syren's calls.

Unknown said...

Srihari: Do you have any references to show the efficacy of UFE treatments performed outside the US? I suspect there have been articles published on the subject and I wonder if this body of information is being cited in the literature here the US.

Srihari Yamanoor said...

Edward, Yes, there are lots of such studies. However, almost none of them have long follow up times. The longest study I have known is a 3 year follow up, with about 85% efficacy. And yes, the studies are used extensively to market the efficacy of UFE.

If you need more details, do let me know.

Johnnie said...

You would think the Fibroid Embolization Technique would get more press than it does; you make some valid points as to why that is. Nice blog... jonni