The Tumors that Science Ignores

By: Adaora Yvonne Ntukogu

What are Uterine Fibroids?

Do you know a disease that up to 70 percent of women will get in their lifetime, a disease whose cause remains mysterious? Uterine fibroids are muscular tumors, usually non cancerous, that grow inside the walls of the uterus. They can grow as a singular tumor or there can be several of them in the uterus with sizes ranging from as small as a pea or larger than a cantaloupe. Many women do not experience any symptoms but for those that do, symptoms may include heavy bleeding, enlargement of the lower abdomen, frequent urination, pain during sex, and lower back pain. These symptoms can make daily living painful and dreadful. Despite the extremely high prevalence of fibroid tumors among women and the increased burden of the condition to the U.S. healthcare system, research remains limited and the public health and economic burden remains in the shadows. 

Although the exact cause of fibroid tumors is unknown, there are several factors that can increase a woman’s risk for developing fibroids. Fibroid tumors become more common as women age and a family history of fibroid tumors increases susceptibility. In fact, if a woman’s mother has fibroid tumors, her risk of having them is about three times higher than average. Obesity and poor eating habits are also linked with higher risks of developing uterine fibroid tumors. Women of all ethnic and racial backgrounds get fibroid tumors; however, it is more prevalent and severe among Black women.[1] Although Black women are disproportionately affected by uterine fibroid tumors, little is understood about what causes these disparities.[1] 

Disproportionate Impact of Fibroid Tumors in Black Women

Black women have a 3-fold increased risk of developing uterine fibroid tumors. Fibroid tumors are also larger and more numerous in Black women, causing severe symptoms and treatment complications.[1] Black women have uterine fibroid tumors diagnosed at earlier ages and are more likely to be symptomatic when compared to White women. Although fibroid tumors are not always symptomatic and do not always require surgery, surgical treatment for fibroid tumors is especially prevalent among Black women due to the earlier age of onset and increased severity of symptoms. 

Black women have higher rates of surgical treatment (i.e. myomectomies, and hysterectomies) compared with White women. The increased rates of surgical treatment among Black women also leads to increased risks of complications after surgery such as infection and bleeding.[2] A study found that among nearly 650,000 hysterectomies performed in California, Black and Asian women were more likely to have a surgical complication, regardless of age and insurance.[2] Less access to hysterectomy alternatives or limited knowledge of nonsurgical treatments may contribute significantly to the higher rate of hysterectomies among Black women.

Uterine fibroid tumors have an adverse impact on fertility and pregnancy. Uterine fibroid tumors have been associated with various complications such as preterm labor and miscarriage.[1] A study compared birth outcomes of women with and without uterine fibroid tumors and found an increased risk of birth complications in women with fibroid tumors regardless of maternal age or ethnicity. However, since Black women face more severe symptoms and have an increased rate of surgical treatments, the burden of birth complications is magnified.[2] 

Scientists believe that a complex set of genetic, physiologic, socioeconomic, and cultural factors likely contribute to racial and ethnic disparities. Despite the differences in incidence and symptoms, there has been a lack of data published regarding the biological basis of fibroid tumors in Black women. However some genetic studies have found that Black women have gene polymorphisms that may lead to poor regulation of fibroid tumors. Despite physical differences, humans are genetically similar. Gene polymorphisms are those variants within DNA that determines the diversity of individuals. There can be certain differences in genes that can make a person more susceptible to certain diseases (i.e. uterine fibroid tumors). 

Research Paucity

Not only is fibroid tumor research minimal, but there is limited racial diversity in existing fibroid tumor studies.[1] Black women remain sparse in fibroid tumor research for several reasons. Many of the important genetic studies of fibroid tumors have come from countries where there are very few Black women. There is also a lack of participation of Black women in studies due to the historic issues of unethical treatment of Black medical study participants (e.g. Tuskegee Syphilis Study). Historically, Black women have been degraded and abused in reproductive studies. James Marion Sims, known as “the father of modern gynecology,” perfected his medical techniques by performing non-consensual reproductive surgeries, like cesarean sections on enslaved black women, often without anesthesia. The distrust and fear of abuse in clinical studies remain today.[1] Although research that focuses on fibroid tumors in Black women is rare, a recent study has linked vitamin D insufficiency with increased fibroid tumor risk in Black women, but there needs to be further research interest to solidify findings.

Public Health and Economic Effects 

Socioeconomic status and race influence access to affordable and appropriate health care. This issue is especially significant in the United States healthcare system because access to certain treatments depends on insurance status. Less invasive surgical treatment methods for fibroid tumors are often only available with private insurance.[1] For example, when hysterectomies are performed, women with private insurance are more likely to undergo less invasive methods, whereas minority women and women with Medicare coverage are more likely to undergo more invasive procedures. Efforts should be made to make fibroid tumor treatment accessible and affordable for women of all socioeconomic statuses. 

There should be more public health discussions surrounding the burden of uterine fibroid tumors on the United States economy.[3] The annual cost of uterine fibroid tumors in the United States is approximately $34.4 billion, and the annual cost of fibroid tumor related care is estimated to be $4.1-9.4 billion. With the extremely high annual cost of uterine fibroid tumors in the United States, it is imperative that scientists and researchers continue to invest in research funding uterine fibroid tumors and health disparities. More importantly, public health interventions should bring more awareness to alternative and less invasive treatment methods for fibroid tumors to decrease risks of surgical complications among Black women. 

References 

[1] Eltoukhi, H. M., Modi, M. N., Weston, M., Armstrong, A. Y., & Stewart, E. A. (2014). The health disparities of uterine fibroid tumors for African American women: a public health issue. American journal of obstetrics and gynecology, 210(3), 194-199.

[2] Jacoby, V. L., Fujimoto, V. Y., Giudice, L. C., Kuppermann, M., & Washington, A. E. (2010). Racial and ethnic disparities in benign gynecologic conditions and associated surgeries. American journal of obstetrics and gynecology, 202(6), 514-521.

[3] Cardozo, E. R., Clark, A. D., Banks, N. K., Henne, M. B., Stegmann, B. J., & Segars, J. H. (2012). The estimated annual cost of uterine leiomyomata in the United States. American journal of obstetrics and gynecology, 206(3), 211-e1.