NCHR Letter to CDC Director Supporting Review of Biopsy Before Hysterectomy or Myomectomy

May 9, 2018

Robert R. Redfield, MD
Director, Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30329-4027

Dear Dr. Redfield:

I am writing to you on behalf of the National Center for Health Research to strongly urge the Centers for Disease Control and Prevention (CDC) to conduct a review to determine the potential benefits of requiring pre-surgical biopsies for women scheduled for hysterectomy or myomectomy (removal of fibroids).

The review is urgent because a recent article that was published in the medical journal Obstetrics & Gynecology reports that the rate of unsuspected cancer is dangerously high in women undergoing these procedures.  When women with undetected cancer undergo those surgeries, especially but not only when the surgery involves a medical device called a power morcellator, the cancer can spread inside the woman’s abdomen, resulting in an early-stage cancer being upstaged to a much more dangerous stage 4 cancer.  Until recently, experts assumed that the risk of these patients having an undetected cancer was less than 1 in 1,000, which was later revised to 1 in 352.  However, the new study indicates that the risks are much higher, and the risk of an undiagnosed uterine cancer is close to 10% for women ages 55 and older.

Researchers from Yale Medical School and the Columbia University College of Physicians and Surgeons studied more than 26,000 women who underwent hysterectomy or fibroid removal. Their finding that undetected cancers were much higher than previously estimated demonstrates that thousands of women are at risk every year.  A review by the CDC would provide important information that could be used to develop new guidelines.  It seems likely that including a biopsy as the standard of care for women undergoing these gynecological procedures could save thousands of women’s lives.

We thank you for your interest and attention to this matter. We strongly urge you to move forward with a review as soon as possible with the goal of developing guidelines pertaining to tissue biopsy methods that will identify women with gynecological cancer before undergoing a surgical procedure to remove the uterus or fibroid.

The National Center for Health Research is a nonprofit research center that conducts and scrutinizes research that can be used to improve public health through better healthcare services, programs, and policies.  We have no financial ties to the products or procedures that we evaluate.


Diana Zuckerman, Ph.D.


See our related statement here.