So we all know that fibroids are super, super common. For people that are looking at me and saying,
Janice you look a little young, you have to know that I'm not that young and I'm gonna be turning 50 shortly and when I turn 50 I will join an exclusive club of women who by age 50, 80% of us, being a black girl,
would be suffering for uterine fibroids. And even if you're not a black girl, just a girl in general, seven out of 10 women, when they reach that age, will have uterine fibroids. It's the leading cause of hysterotomy in the United States with over 300,000 hysterectomies being done
for a benign disease so let's think about that for a second. We're actually everyday trying to figure out how we're treating diseases in the body by leaving the cancer in the liver and ablating it or embolizing it with chemotherapy or internal radiation
and all kinds of things but for a non cancer of the uterus the number one treatment is just take that organ out. Symptoms related to uterine fibroids actually one in five women that go to the gynecologist today it's for something related to their fibroids
and fibroid symptoms are very varied, mostly related to heavy periods, pelvic pain and bulk symptoms and regardless of what that is, I want you to know that there's a high impact on the quality of life and productivity in the U.S. where women wait, on average, around 3 1/2 years
to get help and I tell every woman that comes to talk to me about that. If you had diarrhea five times a day, five times per month, would you go talk to someone about that? How about if you had hematemesis,
five times a month every month? Do you think that you would go see somebody about that? Yet women just suffer with this symptom every month for an average of 3 1/2 years and never see anyone about that. In 2013 Doctor StewarT did a survey of over
1000 women and found that a third of women said that they missed work because of fatigue or cramps or bleeding and this is not something that doesn't cost us a lot. The cost of treating this benign disease, uterine fibroids is around 34 billion dollars
to the U.S. consumer so if you don't even care about that and you're like, I only care about money, here is something to care about. Yet there are no pins that say, let's have an annual women fibroid awareness day but the cost of treating fibroids is on par
for breast cancer, colon cancer and ovarian cancer combined. I think it's time we pay a little bit of attention about that.
And so in 2017 The Society of Interventional Radiology commissioned a different survey and they said let's just find out
if we're doing anything about this, are we making an impact? And they surveyed over a thousand women again to find out about this and even though I stood here and tell you that 80% of black women and 70% of all women will have fibroids
there's still like a quarter of the population who said they've never even heard of fibroids and the people that are women don't even think that they're at risk even though I'm telling you that this is a disease that is so prevalent they have no idea.
And that a full 20% of all women think that their fibroids could be a cancer. Now this misperception really feeds into the treatment because if you think that your fibroids are cancerous it's very hard to hear somebody tell you, okay fine don't worry about it,
let's just keep your cancer inside. But because they think that fibroids are cancerous then the leading treatment remains the leading treatment which is hysterectomy, let's just cut it out. And of those women that are surveyed that say that, again the majority of them have never heard of UFE,
those who are diagnosed with fibroids still say that they were never aware of this being a treatment. The women that had fibroids were never told that uterine fibroid embolization is a possibility, so we have a long way to go.
If you play this video, I want you to hear this video of a patient of mine who needed to seek treatment and her experience trying to find someone to treat her. - [Woman] Not satisfied with the options that I had been given, I decided to do some
research on my own and I started to talk to people and look into things online and at the library and I came across interventional radiology actually at the library. So I read several articles, then I also contacted The Society of Interventional Radiologists in Virginia
and talked to a few people and so then they were talking about the fact that it was an option for a lot of women, that a lot of women didn't know about and I was included in that group of women that did not know about it at that time.
So I proceeded to go to New York to get an opinion and see an interventional radiologist. However, at that time when I went to see the interventional radiologist they had told me that because of the size and the number of fibroids that they really didn't think that this was going
to be a good option for me. So they sort of were saying the same thing that my OBGYN was, was that I should have a complete hysterectomy. However, not being satisfied with that, I didn't stop at just one
and I ultimately came across Doctor Newsome who just gave me the facts and even though she told me at the time that, you know, I was at the high end in terms of age and size for fibroids of being able to get the most
positive result from the embolization that if I still was willing to do it knowing beforehand that I may not get the ultimate result that I wanted, that it was up to me, that she'd be willing to do it. And I am so glad that I did.
- Now this woman doesn't even live in my state. She found me online, she found everything about fibroid embolization in the library. She called the Society of Interventional Radiology and they sent her to someone in New York and eventually she made her way back to Atlanta
for us to have a discussion about it.
So a lot of people are trying to get this. I wanna say that while fibroids are very prevalent, not everybody will experience symptoms from it and the symptoms from uterine fibroids, I like to refer to that as the burden of this disease.
A lot of people are just carrying around these secrets because it's not something that you're likely to openly discuss. I mean we'll talk all about our other diseases but this is like something that is so close, it's a little taboo
no one wants to talk about it. Who wants to say, I have painful sexual intercourse? Who wants to say that every time I cough a little bit THAT I pee? Or I know where every restroom is from here to the expo hall
and by the way I do know where every restroom is from there to the expo hall. But it's a problem if that is what your life is. If you choose to only drink a half a can of Coke because you know that you have frequency and urgency that's a problem
and I'm here to say that we are our sister's keeper and even if you're not a sister and you're a brother you have a sister, you have a mother, you have a coworker, we are responsible for helping each other. So the symptoms are very variable
and the symptom that I think that we often not pay attention to are bowel abnormalities like constipation or diarrhea but I'm gonna show you why this is a very common thing.
So after all these years we still don't know exactly what causes fibroids but there are
a few things that we do know. We know that there's a genetic predisposition, we know that fibroids are familial, it runs in your family. We know that if you stick to a plant based diet then your symptoms tend to be a little bit better. We know that blacks are more common than whites
to get fibroids and that fibroids are responsive to hormones and estrogen is stored in fat so women that are more obese tend to have symptoms that are more likely to be heavier than women that are not as obese. But there's something very special about fibroids
in black women. They're disproportionately affected, we know that, and we actually know this, that when you become menopausal your fibroids begin to shrink, because fibroids are responsive to hormones, but that is not true in black women.
We don't see the actual same response. Not so sure why, an area of research. And here is where my politics is not apparent, and I would say although I'm going to say this statement I've been saying this for a very, very long time.
The symptoms that you experience with fibroids is very much dependent on location, location, location and this is one thing that fibroids have in common with Donald Trump. They actually seek the best real estate that there is in the uterus and
they're all about the location so that if you have a submucosal fibroid, a fibroid that kind of pooches in on the inside, then those fibroids tend to be more involved in bleeding, intramural fibroids are fibroids that are just entirely within the muscle and they just cause
the uterus to get big and they can also cause bleeding and subserosal fibroids are fibroids that pooch more towards the outside and they cause more like the bulk symptoms so it's easy to see, if you look at this picture of a uterus
and a subserosal fibroid hanging out on the outside. Teresa, who wouldn't think that this fibroid is causing bowel abnormalities, right Anna? It's clear as day to see that, you see the bowels right there.
And so when we see women it is important
that we talk about the options and like anything else we're weighing the risk verus the benefits and we're talking about what are the possible treatments, of which uterine fibroid embolization is just one of them and I wanna make sure that even though I do this procedure that I'm telling you
in the room that doing nothing is an important option to explain but if you choose to talk about it or to do nothing there's also a risk and a benefit to doing nothing. And we talk to our women about that.
Because it's important that we present all of these options to women when they're deciding to choose what's the best way to treat their fibroids. You can watchfully wait, medications, and when I say myomectomy I mean whether it's robotic, laparoscopic or open, or hysterectomy.
Based on all those other ways I have not included MRI guided focused ultrasound and now obstetricians are actually going in and doing something called a Flostat where they actually clip the uterine artery or put a clip on it so that they can decrease flow.
But okay I'm gonna talk a little bit about UFE.
This is not a new procedure, this procedure has been around for a very, very long time, first described in 1995 in France by Doctor Ravina and then just two years later Doctor Goodwin, who's here at the conference
starting publishing about doing uterine fibroid embolization in the United States so two years after it was first described we were already doing it here and I'm ashamed to say I'm old enough, I remember when this first presentation was given in the society in 1997.
But in the year 2008 there are over 1200 articles, papers, studies that have been done on uterine artery embolization. One of the most studied disease process that we have yet it's adoption is still far lagging but it's these papers and papers that are
put out by our society that help to inform what we're doing today, right? So in 2014 the society put out a guidelines that help to tell us what we're doing and then in 2008 and last year the Association of Obstetrics and Gynecology, ACOG,
put out there position statement and this is still true and they say that there's level A evidence, good, consistent, scientific evidence that says based on long and short term outcomes, uterine artery embolization is safe, it's an effective option
for appropriately selected women who would like to retain their uteri and they actually just updated this statement to be the exact same thing. So there's really no debate whether or not this procedure works, or if it's safe
between either of our societies.
So how do we decide Mike, who is an appropriate candidate? Cause that's what they said right, the person who is appropriate. And the person that is appropriate is the person that, I mean have fibroids
and it seems so silly that I have that up there Diane, you have to have fibroids but I see women who come off the street with symptoms that are very, very variable. I have heavy, painful menstrual cycles, I have an enlarged abdomen, I have bowel abnormalities
but guess what? They don't have fibroids or they have to have the second thing, that their symptoms must be related to fibroids and then we have to have some kind of imaging that says that this fibroid is causing that symptom.
I'm gonna go a lot faster now as I see my replacement is in the back. So the ideal candidate lucky for us is that most patients that we actually see in clinic are actually ideal candidates for UFE. They can benefit from this
and this is a procedure that we know that you guys have all scrubbed in, you put a catheter in to the main uterine artery, you inject these particles like the grain of sand, they block off the blood supply and although the schematic is showing it as if it's done femorally, in my practice
and in a lot of practices in the U.S. now most of this procedure is done transradially and in the interest of time I'm just gonna say let's not play the video. But we record this sometimes for education. How about if you go to five zero, zero,
somewhere around there, let's see if we can show a little bit of that. We'll try that. - [Man] Think about almost like rocks in a river bed that it starts filling up that river bed. The flow in it is going to go slower
and that's exactly what's happening here. Some definitions people will use, stasis would be complete cessation of flow in the vessel and near stasis, the typical definition that most people use in the inter vascular space is where you see contrast that is still present
in the vessel after five heartbeats. It's the systole that's pushing this forward. Doctor Adele's got excellent technique right now, you see that good forward flow of contrast, no reflux. - [Man] So when we're trying to select these
torturous small arteries we wanna use a catheter that has a preform shape to it. As you can see here there's a hook. - Very insulting to those people in this audience, you're like of course I know that. So can we go to seven two four on that video please?
- [Man] Microcatheter over this wire. - Yeah something like that. (gentle music) So you can see that we're absolutely coming from a radial approach, left radial usually. - [Woman] To document that we're in the uterine artery
and what the flow is. - Okay, all I can see right now are my pimples so we can just skip this video. But just know that we're working from the wrist and we're able to get all the way down and I think that, you know,
even though this is a procedure that we do all the time, I'm never, ever, ever tired of doing this. Every patient is a little bit different and we enjoy doing this because yes, we understand the science of it but also we're able to use now
some of the image guidance, the embolization guidances that are out there to help us to make this a lot faster and I do this because I'm also a little bit of a geek. So you can see in this patient, I don't know if this is supposed to play
but maybe it's not gonna play, you guys can obviously see that this is coming from the left wrist, that you can see the before and after pictures, the pictures that are showing the enlarged hypervascular uterus with fibroid vessels and the ones afterwards
showing the stasis of flow in the uterine artery and I don't have a, oh I do have a pointer, maybe not. It won't matter, a pointer here showing the large uterine arteries and then the stasis of flow. And if you look kinda carefully, please don't
point this out, I didn't want this to be seen you can almost see the little beads there, that is a person that has a heavy embolization procedure done, this was her second procedure being done. So we'll just keep going for the sake of time, you guys have seen these all before
and sometimes we can get pretty impressive results. Look as Miss Brazil, former Miss Brazil. I remember when I saw her, she was wearing Depends and actually tampons and I had to coach her out of the car to come and get her consult done because she was afraid that if she got out
that she was gonna be sitting in a pool of blood. And after embolization she has a near normal looking uterus. I don't wanna say that we get these type
of impressive results all the time because we don't, it's important that we actually
select the right person. But women need to know their options and they say that when they're deciding what doctor they're gonna see, they actually want the doctor that gives them all the options, even if that's not the thing
that they're going to do. And after 20 years of us doing uterine artery embolization still 11% of the population think that hysterectomy is their only option. I think we all have something to do with trying to change that.
Look at these data results. We know that uterine fibroid embolization works. It works short term, it works long term and just last year, 10 year follow up from the EMMY Trial showed that two thirds of all patients were actually spared a hysterectomy
and still actually had resolution of their symptom. And I don't know if I believe this as Doctor Reekers has said, the principal investigator of the EMMY Trial and this was published in the American Journal of Obstetrics and Gynecology.
He said that not offering uterine artery embolization after 10 year data is available should be considered unethical. Well obviously I do fibroid embolization so maybe I would say that. Alright I have four minutes to go through
a bunch of slides so let's talk about two things, which is one of the things that people ask me about all the time. What if I wanna have a baby? And I'd say that the data is very weak in this. Ideally, we don't wanna do uterine artery embolization
in patients for which, that they desire future fertility. We have a consultation and what I do, I actually give them the medical evidence that is available. That we need to know a little bit more,
that right now we know that myomectomy actually increases your chances of becoming pregnant. We have no studies right now that compare UAE to myomectomy but this trial is actually going on and should be almost done. They are accruing patients up to
December and I anxiously await the result of this trial. And that will help us to see what really we're telling our patients. But I tell patients right now that no, no you need to have a myomectomy but I do offer embolization in patients
who are not ideally surgical candidates if they still say they want an embolization after us having a discussion and them going to see their gynecologist.
The reason that we have such a hard time with this it's because even when we tell patients that,
every now and then we actually have a great result. We tell people that they should have a myomectomy and then they have a UFE and then guess what? This happens, they come back, this is a patient of ours, 30 years old, wanted to have a baby, we sent her
to have a myomectomy, she said no, I still wanna have an embolization and guess what, they get pregnant and they have a normal baby and because we do have these anecdotal studies where that happens and it becomes really, really hard
for us to tell patients really. So I'm anxiously awaiting the data on that.
Alright I'm not gonna go through that but there are other patients that I say are really not ideal candidates. Mike I'm almost done. And the non ideal candidates are patients
that we're worried about whether or not they have a cancer and you guys have probably seen enough MRIs now to know that these are not normal MRIs. When you have an MRI that looks like that this is not a fibroid and so it's important to stress that imaging is a part of the process.
That you need to be able to decide who are the best candidates for this procedure. So this is a patient of mine that came to clinic and my astute PA actually just felt her belly and said, I've felt a lot of bellies, this doesn't feel like it's a normal one.
We got an MRI, this patient had an endometrioid cancer. And it's easy to see that this patient also has an endometrioid cancer, look at this. There's actually no margins whatsoever for where the uterus is and where this thing is and this patient just came to clinic
with oh bulk symptoms, please evaluate for fibroids.
So yes, we treat people who have fibroids, who have symptoms of fibroids but part of our responsibility is figuring out who are the absolute best candidates. We know that we can do this, we know that we can
do this safely, we know that we can help patients with bleeding and bulk symptoms. We know that people could recover and go back to work within a week or so, maybe two weeks, that we can preserve the uterus in patients and sometimes we get lucky
and patients become pregnant and because we're so awesome at imaging we can actually help to find some cancer in patients. So, because I'm actually almost done with time I'm gonna stop here, but to tell you one thing is that as it relates to cancer and fibroids.
Fibroids are not a cancer, but in the same uterus fibroids can live with cancer and a few years ago the FDA put out a warning about this and on their website this is what is written and this is what I tell patients, that the FDA says that there's a chance
that you can have a cancer hidden in your fibroid uterus, one in 350. And ACOG says that is way too high and so they quoted one in 500 and then the interventional radiology community looked at their data and so this is what I tell patients,
that there's a one in 1000 chance that there could be a cancer hidden there. This is the last thing I have to say and it's an advice from that same patient of mine that took off from work, drove across state lines to take her disease in her own hands
and find someone who could do embolization for her. So can you play this please or maybe I can play this. Could you have volume, Mr sound man? - [Woman] Advice to you is to listen to - Little higher - [Woman] Your healthcare professional,
ask questions but most importantly do your own research and find out everything that you can about what options are available to you and even if they give you an option and you're not satisfied with that option don't just stop there.
Go and see someone else, get a second opinion, get a third opinion, even a fourth opinion if you have to and try to find someone who not only understands what is going on with you but that's willing to listen to you because that's really important
that they hear what it is that you're saying and understand what it is that you need in order to be able to find a successful treatment option for you and if you're considering interventional radiology I would say start there (laughs) actually.
Because it is a procedure that can give you your life back and you don't have to give in and suffer with uterine fibroids and talk to people. - I think I'll stop here, thank you very much for your attention and (audience applauds)
I'll be around if you have any questions, thanks.
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