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Unnecessary hysterectomy more likely for less affluent women

May 13, 2002

Unnecessary hysterectomy is less likely to be carried out on affluent women, shows research in the Journal of Epidemiology and Community Health.

Hysterectomy is one of the most common and controversial of all surgical procedures in the developed world. Rates vary from 10 per 10 000 women in Norway to 60 per 10 000 women in North America.

Italian researchers assessed the socioeconomic status of 3141 women living in Rome from hospital discharge records. Aged 35 and older, the women had undergone hysterectomy in 1997. The data were plotted against overall hysterectomy rates, and those carried out for benign or malignant disease.

The overall hysterectomy rate was 36.7 for every 10 000 women aged 35 and above, which is similar to the rate in England, and almost double that in Scandinavian countries, comment the authors. Over four out of 10 operations were carried out for fibroids, a benign womb tumour (leiomyoma). Fibroids were most common in women under the age of 50 and accounted for 57 per cent of hysterectomies in this age group.

The rate of hysterectomy for benign disease was 35 per cent higher in the poorest women compared with those who were most well off. Yet fibroids are reportedly more common among affluent women, say the authors.

The authors conclude that wealthier women probably opt for modern, less invasive treatments for benign tumours, and that a lack of information about their options makes women on low incomes more likely to comply with an offer of hysterectomy. The high rate of inappropriate surgery in women of reproductive age, say the authors, is worrying, given the alternative treatments available to treat fibroids.

British Medical Journal (BMJ)

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