A growing body of evidence suggests that uterine artery embolization (UAE) is a viable alternative to surgery for symptomatic fibroids for women who don't desire future pregnancy. For many women, avoiding surgery is a tremendous relief. However, there are still unanswered questions about the safety and efficacy of UAE. This story reports on a randomized controlled trial published in this week's New England Journal of Medicine comparing UAE to surgery for symptomatic fibroids. This story does a good job of explaining the problem of fibroids, describing the treaments compared and why UAE is an important advancement. However, this story is limited by the lack of balance in its sources and leaving out important information on the costs and availability of the procedure.
The story accurately describes the prevalence and symptoms of uterine fibroids. The story provides adequate quantification of some of the most important things for consumers to know, such as the fact that after a year, there were no differences in the quality of life of the women assigned to UAE compared to those assigned to surgery and that 13% of those who underwent UAE had a repeat hospitalization, mostly for surgical intervention because of failure of UAE to achieve the desired results. The story could have provided more quantification of other pieces of information that women would want to know, such as length of hospital stay, time to return to work, or risk of serious adverse events.
The story implies that UAE is a new procedure. The story could have mentioned that the procedure has been performed for more than 10 years in Europe and the US. The story does mention some of the potential harms of UAE, such as the need for repeat procedures for treatment of recurrent symptoms and the fact that there are questions about safety of pregnancy after the procedure. The story should have also mentioned the potential for ovarian failure, causing infertility, infection, delayed complications and a small risk of emergency hysterectomy.
However, the story does not state whether uterine artery embolization (UAE) is available and if so, how widely. And availability is a real issue. It requires expertise in interventional vascular radiology and an interest in the female pelvic anatomy. Facilities offering the procedure would need strong links between gynecologists and radiologists to provide coordinated assessment and care. This is not explained in the piece. The story also does not describe the costs of UAE and how they compare to costs of surgery. The cost of UAE is quite high and for some women may not be covered by insurance.
The story does not describe the costs of uterine artery embolization or how they compare to costs of surgery. The cost of UAE is quite high and for some women may not be covered by insurance.
The story provides adequate quantification of some of the most important things for consumers to know, such as the fact that after a year, there were no differences in the quality of life of the women assigned to uterine artery embolization compared to those assigned to surgery and that 13% of those who underwent UAE had a repeat hospitalization, mostly for surgical intervention because of failure of UAE to achieve the desired results. The story could have provided more quantification of other pieces of information that women would want to know, such as length of hospital stay, time to return to work, or risk of serious adverse events.
The story does mention some of the potential harms of uterine artery embolization, such as the need for repeat procedures for treatment of recurrent symptoms and the fact that there are questions about safety of pregnancy after the procedure. The story should have also mentioned the potential for ovarian failure, causing infertility, infection, delayed complications and a small risk of emergency hysterectomy.
The story adequately describes the design of the current study.
The story accurately describes the prevalence and symptoms of uterine fibroids.
The story only uses quotes from the original article and accompanying editorial. It doesn't appear that the authors were even interviewed. The story should have quoted other clinicians/researchers who were not related to the study who could have provided some perspective on what this new information means for clinical practice.
The story does mention alternative options such as myomectomy (surgical removal of the fibroids), hysterectomy (surgical removal of the uterus) in addition to uterine artery embolization. The story could have mentioned other treatments such as watchful waiting, pain medications or birth control pills.
The story does not state whether uterine artery embolization (UAE) is available and if so, how widely. And availability is a real issue. It requires expertise in interventional vascular radiology and an interest in the female pelvic anatomy. Facilities offering the procedure would need strong links between gynecologists and radiologists to provide coordinated assessment and care. This is not explained in the piece.
The story implies that uterine artery embolization is a new procedure. The story could have mentioned that the procedure has been performed for more than 10 years in Europe and the US, although it has been limited to mostly academic hospitals.
There is no way to know if the story relied on a press release as the sole source of information, although it is noteworthy that the story only uses quotes lifted from the published study and from an accompanying editorial. It doesn't appear that these people were actually interviewed.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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