Interventional News speaks to Jemianne Bautista-Jia about her research on uterine fibroid embolization (UFE). “Being in the same demographic as my patients allows me to realistically consider what I would want in their situation,” she says. Bautista-Jia calls for interventional radiologists to become better at marketing themselves, as she believes increasing awareness of the minimally-invasive possibilities offered by interventional radiology will foster the greater multidisciplinary collaboration necessary to best serve patients with uterine fibroids. She also acknowledges that more work needs to be done to collect data on the plausibility of pregnancy follower UFE.
What did you learn from this study?
Firstly, that UFE is safer than surgery with a lower rate of post-procedure blood transfusions. I think this is primarily due to the more invasive nature of the procedure [myomectomy], resulting in greater blood loss compared to UFE. Other studies corroborate our results such as the retrospective study published by Narayan et al in the Journal of Vascular and Interventional Radiology (JVIR) in 2010.
One of our most surprising findings was that UFE resulted in a much higher rate of improvement in menorrhagia when compared with myomectomy. Seventy-five percent of patients in our UFE group reported an improvement in menorrhagia, versus only 50% in our myomectomy group—menorrhagia is the most common symptom that patients present with. Being a woman myself, I think that if I had symptomatic fibroids, I would rather have a procedure where you do not have a large incision, and you avoid the complications that can come with surgery such as blood loss and the development of adhesions which put you at risk for complications in the future.
Why do you think so many potential patients do not know about UFE, and what role can interventional radiologists play in spreading the word?
Firstly, a patient’s primary care physician is normally an internal medicine specialist or an obstetrician gynaecologist. Those are the doctors that patients see consistently, whereas interventional radiologists are specialists only seen by referral, at least in the USA. Those physicians are the gateway to get to interventional radiology, and may not be aware of this procedure. Maybe this lack of awareness is on us for not being more vocal about this procedure, and for publishing in journals that are specifically read by interventional radiologists. We need to be more proactive in letting other specialties know about this procedure, so they know it is an option to offer to their patients.
Additionally, if patients are seeing obstetricians and gynaecologists for their problems, and obstetricians and gynaecologists are the ones performing myomectomies, of course they are more familiar with that procedure, and are probably more inclined towards keeping those patients and providing comprehensive care.
We also need to be more vocal about what our specialty is and what procedures we do, to reach patients directly, and to educate the wider public on what it is that interventional radiologists do. We have to be better at marketing ourselves and our procedures.
Another reason may be, as studying fibroids is a relatively young branch of research, there is not enough data yet proving the safety of UFE in terms of pregnancy outcomes after the procedure. I think the most important thing interventional radiologists can do is to build a registry of patients who had UFE and who attempted to conceive following the procedure, so we can see whether it is safe or not. Being able to assuredly offer a minimally invasive treatment to patients with uterine fibroids who want to later get pregnant would be hugely valuable. We need to have more data for how UFE affects the plausibility of pregnancy post-procedurally.
The late Dr Pisco’s recent research in patients receiving conventional or partial UFE suggested that the procedure may actually aid in fertility. Particularly partial UFE in which only the arteries feeding the fibroids were embolised appeared to reduce the risk of infertility. These findings should be further explored.
Why do you think it is important to work with obstetricians and gynaecologists?
I think it is of the utmost importance, you have to have good relationships with all the physicians in your hospital, because of course everyone has something important and valuable to contribute to patient care. In specific situations, other specialities’ inputs and experiences may be more important for a patient and can help you to look at the situation from a different point of view. If any group is working in isolation, that is a disservice to the patient, because the treatment options are limited.
However, many women are not receiving fibroid embolizations- a study published by NEJM found that, in the USA, just a few thousand patients receive UFEs each year, compared to around 200,000 who have hysterectomies. Some of these hysterectomy patients likely could have been treated with UFE and had their uteruses preserved, so the collaboration is clearly not as strong as it could be in an optimal scenario. We still have a way to go.