Racial and ethnic disparities in benign gynecologic
conditions and associated surgeries
Vanessa L. Jacoby, MD, MAS; Victor Y. Fujimoto, MD; Linda C. Giudice, MD, PhD, MSc;
Miriam Kuppermann, PhD, MPH; A. Eugene Washington, MD, MSc
necologic conditions and the use of sur-
gical treatments have been reported.
These differences may result in signifi-
cant health disparities among some ra-
cial and ethnic groups. Although there
are many areas of gynecology to con-
acial and ethnic differences in the
prevalence of common benign gy-
mors and endometriosis, which are 2 of
the most common conditions that are
encountered in clinical practice, and
hysterectomy, which is the most fre-
quently performed major gynecologic
surgery. Our review will highlight racial
and ethnic differences in the burden of
disease that is associated with fibroid tu-
mors and endometriosis and in the rate,
route, and outcomes of hysterectomy.
We will emphasize the need for further
research to better understand the rea-
sons for these racial and ethnic differ-
ences, with the goal of decreasing signif-
icant health disparities.
The cause of racial and ethnic differ-
ences in these gynecologic conditions
ciodemographic, cultural, and eco-
nomic factors likely contribute to ra-
cial and ethnic disparities, which has
been described in other fields of medi-
cine.1,2Differences in patient prefer-
ences by race and ethnicity may also
influence treatment decisions that re-
sult in differential rates of surgery.
There are also challenges in the mea-
surement and categorization of race
and ethnicity that hinder a complete
understanding of racial and ethnic
variation for gynecologic conditions.3
We will examine some of the potential
and describe limitations in the litera-
ture that create significant knowledge
Uterine leiomyomas (fibroid tumors)
alence of fibroid tumors among black
However, these studies evaluate women
who are undergoing hysterectomy or
represent the true distribution of fibroid
tumors in the general population; racial
and ethnic variation in disease severity,
ment preferences may result in a higher
prevalence of surgery among black
women. One study attempted to over-
come this limitation by screening ran-
domly selected women who were 35–49
years old for fibroid tumors with pelvic
justed for body mass index (BMI) and
parity, black women were nearly 3 times
as likely to have fibroid tumors com-
pared with white women (odds ratio
[OR], 2.7; 95% confidence interval [CI],
2.3–3.2).7Two other studies included
women who underwent surgical man-
agement of fibroid tumors and those
who did not. Among 95,061 premeno-
pausal participants in the Nurses Health
Study II, black women had 3 times the
odds of receiving a diagnosis of fibroid
tumors by pelvic examination, ultra-
sound scans, or hysterectomy compared
with white women (OR, 3.3; 95% CI,
who received either surgical or medical
management of fibroid tumors, black
apparent fibroid tumors (OR, 9.4; 95%
Received Oct. 7, 2009; revised Jan. 24, 2010;
accepted Feb. 15, 2010.
Reprints: Vanessa Jacoby, MD, MAS, UCSF
Women’s Health Clinical Research Center,
1635 Divisadero St., Suite 600, San Francisco,
CA 94115. firstname.lastname@example.org.
This study was supported in part by the
Women’s Reproductive Health Research
Career Development Program (Grant K12
© 2010 Mosby, Inc. All rights reserved.
Common gynecologic conditions and surgeries may vary significantly by race or ethnicity.
Uterine fibroid tumors are more prevalent in black women, and black women may have
larger, more numerous fibroid tumors that cause worse symptoms and greater myomec-
tomy complications. Some, but not all, studies have found a higher prevalence of endo-
metriosis among Asian women. Race and ethnicity are also associated with hysterectomy
rate, route, and complications. Overall, the current literature has significant deficits in the
identification of racial and ethnic disparities in the incidence of fibroid tumors, endome-
triosis, and hysterectomy. Further research is needed to better define racial and ethnic
differences in these conditions and to examine the complex mechanisms that may result
in associated health disparities.
Key words: benign gynecology condition, fibroid tumor, surgery
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