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Read Original Story

Treating fibroids without surgery

Rating

4 Star

Treating fibroids without surgery

Our Review Summary

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.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

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.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

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.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

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.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story adequately describes the design of the current study.

Does the story commit disease-mongering?

Satisfactory

The story accurately describes the prevalence and symptoms of uterine fibroids.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

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.

Does the story compare the new approach with existing alternatives?

Satisfactory

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.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

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. 

Does the story establish the true novelty of the approach?

Satisfactory

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.

Does the story appear to rely solely or largely on a news release?

Not Applicable

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.  

Total Score: 6 of 9 Satisfactory

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