Barbara Levy, MD, on Uterine Fibroid Treatment Outcomes in Black Women

A recent study investigated the potential for laparoscopic radiofrequency ablation (LAP-RFA) as a uterus-sparing treatment option for Black women with uterine fibroids (UFs).

The researchers conducted a subgroup analysis of participants from the LAP-RFA Pivotal Trial, including 28 White women and 46 Black women. At baseline, Black women had more UFs than White women (7.3 vs 3.7, respectively), greater symptom severity score, and lower health-related quality of life score. However, 36 months after LAP-RFA, differences in symptom severity score and health-related quality of live were no longer present.

Consultant360 reached out to Barbara Levy, MD, clinical professor of obstetrics and gynecology at The George Washington University School of Medicine and Health Sciences and voluntary clinical professor of obstetrics, gynecology and reproductive sciences at UC San Diego School of Medicine to further discuss these findings.

Consultant360: Why was it important to examine treatment outcomes in this specific population?

Barbara Levy, MD: It is important for practicing health care professionals to base our care on evidence in the literature, but the evidence only applies to the specific population that may have been studied. One of our major problems in trying to apply evidence-based medicine practices is that many studies have included and reported on a select group of patients. Since fibroids disproportionately impact women of color–specifically African American women in the US–we felt it was extremely important to understand how effective radiofrequency ablation for fibroids is in the group of women with the greatest burden of disease. In order to promote equity in health interventions and outcomes, we wanted to study this specific population. We were gratified that 34% of the study population were Black women as opposed to the more typical 5% found in other studies.

C360: Did any other patient characteristics play a role in your results beside race?

BL: We looked at other characteristics like the number of fibroids the patient had, how many were treated, and other demographic information like the patient’s age. We stratified by race because we wanted to be sure that the results we report apply to the population most affected by fibroids.

C360: Were your results surprising to you?

BL: The results were gratifying but not surprising. We saw that Black women started out with a greater burden of disease, had more fibroids and longer surgical procedures. It was great to see that despite this, their outcomes were equivalent to those for white women. In fact, the disparities in quality of life that existed before surgery were eliminated in the follow-up quality of life surveys. So, improvement in QOL for Black women was significant after treatment of their fibroids without any increase in complications of surgery.

C360: How do your findings contribute to the existing literature about this topic?

BL: This information helps us understand that even though Black women have a greater burden of disease with uterine fibroids, they can be effectively treated with a technology that spares the uterus–avoiding hysterectomy. By looking at our data stratified by race we were able demonstrate that laparoscopic radiofrequency ablation of uterine fibroids is an effective uterine-sparing procedure that works well even for the population with a larger burden of disease.

C360: What remaining knowledge gaps should future studies address?

BL: We need to understand the impact of treatment for uterine fibroids on fertility and pregnancy outcomes. In addition, it will be important to try to follow women long-term—even until menopause—so we can begin to understand how many people will need more interventions over time. Since uterine-sparing procedures do not prevent more fibroids from forming, it will be helpful to have data on how often symptoms come back as more fibroids grow.

Reference:

Berman JM, Bradley L, Hawkins SM, Levy B. Uterine fibroids in black women: a race-stratified subgroup analysis of treatment outcomes after laparoscopic radiofrequency ablation. JWH. Published online July 20, 2021. https://doi.org/10.1089/jwh.2020.9001