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Hysterectomies: Women
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Hysterectomies are usually performed under the strict conditions of a hospital operating room. The procedure is generally performed by a gynecologist, a medical doctor who has specialized in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics.
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A new study shows that as many as 10 million women who have had hysterectomies and who no longer have a cervix are still receiving Pap tests to screen for precancerous cells in tissue scraped from the cervix. The study’s lead author, Dr. Brenda E. Sirovich, a research associate at the Outcomes Group at the Veterans Affairs Medical Center in White River Junction, VT, said that testing women without a cervix can lead to false positives and wasted money, with tests ranging from $20 to $40. The study did not include women who have had a hysterectomy and still have a cervix. About 12 percent of the 85 million women who are currently being screened have unnecessary Pap tests, said Dr. Sirovich. The study, published in The Journal of the American Medical Association, analyzed national data on Pap testing and on hysterectomies over 10 years. When a woman does not have a cervix, a doctor scrapes cells from her vagina instead.
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The study examines the direct cost of hysterectomies by surgical approach and to estimate the impact on costs if more vaginal hysterectomies were substituted for abdominal hysterectomies for women under 50 years of age. Eleven Ontario, Canada hospitals provided 1994 cost data based on 1376 hysterectomies. These data were applied to all hysterectomies performed in the province for women under 50 to estimate the cost of subtotal, vaginal (VH), or laparoscopically assisted vaginal hysterectomy (LAVH) relative to total abdominal hysterectomy (TAH). The change in costs were determined, if TAHs in Ontario in 1994/95 had been substituted by VH or LAVH. Teaching and community hospitals were considered separately. VH was less costly than TAH, subtotal, or LAVH.
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Study findings indicated a limited, yet significant increase in the rate of hysterectomies during 1994--1998. From 1994 through 1999, one in every nine women aged 35--45 years had a hysterectomy. Women aged 40--44 years had a significantly higher rate of hysterectomies than all other age groups. The most common primary diagnoses for a hysterectomy were uterine leiomyoma, endometriosis, and uterine prolapse (3). Approximately one half of the women who had a hysterectomy ... had a bilateral oophorectomy. Rates of vaginal hysterectomies remained stable, although the proportion of women who had an LAVH increased significantly by >2-fold.
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ALTERNATIVES: Dr. McLucas says one-third of all hysterectomies are done to treat uterine fibroids -- a common condition that affects up to 40 percent of women. Fibroids can cause pain, heavy bleeding, infertility and multiple miscarriages. Dr. McLucas says uterine artery embolization, which has been studied for more than one decade, is a safe and effective alternative to hysterectomy for the treatment of fibroids. During the procedure, tiny particles are injected into the uterine arteries. Once there, they block blood flow to the fibroid tumors, thereby shrinking them. Dr. McLucas says, "The fibroids are going to shrink at least 50 percent, and they'll never come back."
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The Inquiry found that Dr Neary carried out 188 peripartum hysterectomies in 25 years, some on very young women of low parity. The average consultant obstetrician carries out 5 or 6 of these operations in their entire career. The judge ... found that numerous patient files had disappeared from the hospital, obviously removed by people sympathetic to Michael Neary, she wrote. She was unable to find out who removed the files but believes the person to be female. She criticised the 'Catholic ethos' of the hospital at the time. Sterilisation was forbidden, contraception was unavailable, but she reported that 'secondary' sterilisations were commonly and sympathetically carried out on women who did not want more children but were forbidden to use contraception by the Church.
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