General Obstetrics and Gynecology
High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence,☆☆,

https://doi.org/10.1067/mob.2003.99Get rights and content

Abstract

Objective: Uterine leiomyoma, or fibroid tumors, are the leading indication for hysterectomy in the United States, but the proportion of women in whom fibroid tumors develop is not known. This study screened for fibroid tumors, independently of clinical symptoms, to estimate the age-specific proportion of black and white women in whom fibroid tumors develop. Study Design: Randomly selected members of an urban health plan who were 35 to 49 years old participated (n = 1364 women). Medical records and self-report were used to assess fibroid status for those women who were no longer menstruating (most of whom had had hysterectomies). Premenopausal women were screened by ultrasonography. We estimated the age-specific cumulative incidence of fibroid tumors for black and white women. Results: Thirty-five percent of premenopausal women had a previous diagnosis of fibroid tumors. Fifty-one percent of the premenopausal women who had no previous diagnosis had ultrasound evidence of fibroid tumors. The estimated cumulative incidence of tumors by age 50 was >80% for black women and nearly 70% for white women. The difference between the age-specific cumulative incidence curves for black and white women was highly significant (odds ratio, 2.9; 95% CI, 2.5-3.4; P < .001). Conclusion: The results of this study suggest that most black and white women in the United States develop uterine fibroid tumors before menopause and that uterine fibroid tumors develop in black women at earlier ages than in white women. (Am J Obstet Gynecol 2003;188:100-7.)

Section snippets

Study participants

A prepaid urban health plan, which is estimated to have approximately 50% black membership and a broad socioeconomic base, was chosen for the NIEHS uterine fibroid study. The study was approved by the Human Subject's Review boards at the NIEHS and at George Washington University. Participants gave informed consent. A random sample of women, aged 35 to 49 years, was selected from a computerized list of members. This age range was selected because it includes late premenopausal years. Because

Results

Eight percent of the original random sample of black and white health plan members could not be contacted or refused screening. Participation was 83% among the screened and eligible black and white women who were contacted (Table I). Compliance with the protocol was generally good and resulted in ultrasound data for 87% of premenopausal participants. Study participation was similar for black and white women (Table I). The black and white participants were similar in age, but differed in

Comment

The NIEHS uterine fibroid study provides data on the cumulative incidence of uterine fibroid tumors that are based on ultrasound screening of a randomly selected sample of women. Black women were more likely than white women to have fibroid tumors. Proportionately more black women had had a hysterectomy for fibroid tumors. Among the premenopausal women, black women were more likely than white women to have had a previous diagnosis of uterine fibroid tumors. Even among women with no previous

Acknowledgements

Clarice Weinberg and Dale Sandler aided in design of the study. Vanessa Barnabie provided gynecological assistance at George Washington University Medical Center. Glenn Heartwell managed the data collection, with the assistance of Regina Davis, Tessie Gabriel, Susie Covington, and other staff at Coda Research, Inc. Allen Wilcox, Jane Schroeder, and Glinda Cooper reviewed an earlier draft of the manuscript.

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    The study was conducted in Washington, DC.

    ☆☆

    Supported by the intramural program at the National Institute of Environmental Health Sciences, with support from the Office of Research on Minority Health, National Institutes of Health.

    Reprint requests: Donna Day Baird, PhD, Epidemiology Branch, 111 TW Alexander Dr, Bldg 101, Rm 308, South Campus, National Institute of Environmental Health Sciences, Mail Drop A3-05, Research Triangle Park, NC 27709. E-mail: [email protected]

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