Association of race, age and body mass index with gross pathology of uterine fibroids
ABSTRACT To determine the associations of race, age and body mass index (BMI) with the gross pathology parameters of uterine leiomyomas in premenopausal women undergoing hysterectomy or myomectomy.
Participants (N = 107) were recruited from surgical rosters of the George Washington University (GWU) Medical Center Gynecology Department as part of the National Institute of Environmental Health Sciences Fibroid Study. Tumor data and patient demographics were obtained from clinical reports, pathology forms and interviews.
Surgical cases consisted of 78% African Americans, 13% Caucasians and 9% others (non-African American, non-Caucasian or race unknown). This proportion of African Americans was significantly higher than the distribution of GWU health plan participants. Fibroids were localized predominantly within the intramural region. Subserosal tumors were more common in patients with more than 9 tumors. African Americans had the highest mean BMI and mean myomatous uterine weight.
African Americans were the disproportionate majority coming to surgery for fibroids. The average BMI and uterine weight were greater in African Americans than in Caucasians, although these differences were marginal. Race did not influence the size, location or number of fibroids in these surgical cases. Subserosal tumors were more common in patients with more than 9 tumors.
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ABSTRACT: According to the National Health and Social Life Survey, the preva-lence of sexual dysfunction among women in the United States is 43%. Despite findings that nearly 50% of all female patients have complaints related to sexuality, only 18% of practitioners report routinely obtaining a sexual history. To further complicate this issue, when sexual dysfunction is present, patients are often unwilling to address the subject with their respective physicians. As primary reasons for avoiding the subject of sexual dysfunction, patients cite fear that the clinician will dismiss their concerns, the clinician will be uncomfortable discussing sexuality, or no effective treatment will be available to treat the problem. Over the past decade, sig-nificant strides have been made in the field of sexual dysfunction. Clinicians have developed a better understanding of the psychologi-cal and physical mechanisms contributing to this array of disorders. Effective pharmacologic therapy for the treatment of male sexual dysfunction is readily available. Development of comparable therapy for women is under investigation. Given the recent dynamic nature of the field, as well as the large number of affected patients, it behooves the astute practitioner to be well versed in understanding disease mechanisms related to sexual dysfunction, their diagnosis, and possible treatment modalities. Needs Assessment: The diagnosis and management of pain associated with sex is a topic that is poorly taught in postgraduate residency education. As a result, these disorders are not as likely to be identified and treated in a timely and effective fashion. Having an organized list of possible causes of sexual pain disorders can potentially be of great benefit to the active practitioner. Learning Objectives: • List the possible causes of pain associated with sex. • Describe the physical examination associated with each anatomic cause of pelvic pain. • Explain the roles of medical and surgical treatment in the management of pain with sex. Target Audience: Primary care physicians and psychiatrists. CME Accreditation Statement: This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Mount Sinai School of Medicine and MBL Communications, Inc. The Mount Sinai School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Credit Designation: The Mount Sinai School of Medicine designates this educational activity for a maximum of 3 AMA PRA Category 1 Credit(s) TM . Physicians should only claim credit commensurate with the extent of their participation in the activity. Faculty Disclosure Policy Statement: It is the policy of the Mount Sinai School of Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the plan-ning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclo-sure to the audience of their discussions of unlabeled or unapproved drugs or devices.
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ABSTRACT: 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 myomectomy complications. Some, but not all, studies have found a higher prevalence of endometriosis 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, endometriosis, 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.American journal of obstetrics and gynecology 06/2010; 202(6):514-21. DOI:10.1016/j.ajog.2010.02.039 · 3.97 Impact Factor
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ABSTRACT: To evaluate the influence of BMI on the prevalence of fibroids and uterine weight. Uterine pathology specimens of all the women who underwent hysterectomy for benign indications from 1995 to 2002 were studied. Patient characteristics such as age, race, body mass index (BMI), and parity were collected by chart review. The data were statistically analyzed using a 1-way analysis of variance and regression analysis. Uterine weight and fibroids were the dependent variables and BMI, age, and parity were the independent variables. The correlation between BMI and the presence/number of fibroids and their size was also studied. Among the 873 patients who underwent hysterectomy for benign indications, 47.1% were obese and these women had the highest mean uterine weight of 349.53 g. Overall, BMI had a significant correlation with the uterine size (P<0.0001). For every 1-point increase in BMI, uterine weight increased by 7.56 g. BMI positively correlated with uterine size both in the women with fibroids (P=0.038) and in those without fibroids (P=0.016). After controlling for fibroids, every 1-point increase in BMI resulted in an increase of 4.56 g in uterine weight (P<0.0001). In addition, there was a significant correlation between BMI and the presence of fibroids (P<0.0001), but not with the size of fibroids (P=0.11). A significant correlation was found between BMI and uterine weight in all the women, independent of age and parity. For every 1-point increase in BMI, there was a 7.56 g increase in uterine weight. This association needs to be further assessed in healthy women without uterine pathology.International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists 09/2010; 29(6):568-71. DOI:10.1097/PGP.0b013e3181e8ae64 · 1.63 Impact Factor