By Dow Jones Business News,
May 09, 2014, 08:23:00 PM EDT
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
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 email@example.com
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