In a surgical advance that benefits tens of thousands of women a year, doctors can now remove a woman's uterus through an incision in her belly button, reducing recovery time for a hysterectomy from four to six weeks to three to five days.
But this advance comes at a terrible price for some.
A small number of women – the precise number is unknown – are effectively sentenced to death by a version of this procedure that can spread cancer cells as the uterus and any growths on it are pulverized to fit through the tiny incision, a process called morcellation.
Amy Reed, 40, is one of those women. The Boston doctor has six children under 13, a husband who's a surgeon, and a thriving medical practice. She treated Boston Marathon bombing victims last spring, as well as Dzhokhar Tsarnaev, who is charged in the attack.
Now she also has stage 4 cancer, with an 85% chance of death within five years.
HOW IT HAPPENED
Doctors had checked Reed for cancer before her hysterectomy last fall and all tests were negative. She was told her hysterectomy with morcellation was a routine procedure to end bleeding from fibroids, benign growths on her uterus. Morcellation is used in at least 11% of the nearly 500,000 hysterectomies performed annually in the USA.
But in retrospect, it became clear that she did have cancer, a fairly rare form called uterine leiomyosarcoma that doesn't show up on preoperative tests.
The morcellation spread those cancerous cells throughout Reed's abdomen, turning a dangerous but treatable disease into a terribly lethal one.
She and her husband, Hooman Noorchashm, have launched a campaign against the procedure, hoping to protect other women. Their story has grabbed headlines in mainstream news media, as well as prestigious science journals, such as an editorial last week in JAMA, the Journal of the American Medical Association.
A researcher friend has shown that morcellation worsens cancer more often than was believed – in as many as 1 of every 400 patients, instead of 1 in 10,000.
The couple have gathered more than 3,600 signatures on a Change.org petition asking for a stop to the surgery.
There is a fix for the problem: surgeons could put a bag around the organs and chopping device so the cut-up tissue – and any cancer cells that might be present – wouldn't be spread.
But adding a bag requires more training and time for surgeons, which would make the procedure more costly.
MAKING A CHANGE
The Boston hospital where Reed had her surgery, Brigham and Women's, says it is working to develop new technology that will make the procedure safer.
After Reed's husband, who works at Brigham, raised questions about the procedure, "we standardized, reaffirmed and formalized both the pre-operative work-up and the informed consent process, as well as the recommendations for eliminating the use of morcellation in certain groups, particularly in women over the age of 45," hospital spokeswoman Lori Schroth said in an e-mail.
Women whose cancer is spread or "upstaged" by morcellation may not even know that the surgery they thought was helping made their problem much worse.
And most women aren't told of the risk, said Brian Van Tine, a cancer specialist at Barnes and Jewish Hospital and Washington University in St. Louis.
Van Tine, who doesn't perform the procedure, said he's documented the upstaging in four of his patients over the last few years.
"There are probably more but they're not alive for me to ask if they had this procedure," he said. "That's four too many."
Reed is now getting aggressive treatment for her cancer. She has taken a leave of absence from work to focus on her treatment, her children and their campaign.
"If this could happen to two physicians at a world-class hospital, this is happening to thousands women across the U.S. and across the world," she said in a phone interview. "They have no voice, they don't know what's going on. ... This is hurting a lot of people and they don't even know it."