Study Objective: To characterize the short-term incidence of gynecologic cancer after undergoing uterine artery embolization (UAE). Design: Retrospective cohort study. Setting: Commercial insurance claims database. Patients: Total of 15 393 United States women aged 18 to 64 years who underwent UAE between 2007 and 2017.Interventions: We used the IBM MarketScan (Armonk, NY) claims to identify adult women without previous gynecologic cancer diagnoses undergoing UAE between 2007 and 2017. Database queries identified women with any diagnostic or procedure codes related to gynecologic malignancies occurring in the first 3 years after UAE. A malignancy diagnosis was suggested by recurrent malignancy-related claims not linked exclusively to diagnostic testing (e.g., transvaginal ultrasound) and malignancy codes linked to tissue pathology claims. Incidence of malignancy diagnosis was calculated. Rates of endometrial sampling in the year before UAE were identified. Measurements and Main Results: Thirty-one women undergoing UAE had gynecologic cancer diagnoses within 3 years of the procedure (22 of 31, 71% uterine cancers; 7 of 31, 23% ovarian cancers; and 2 of 31, 6% cervical cancers). On average, cancer diagnoses were made 1.1 § 0.9 years after UAE. One in 497 women undergoing UAE was diagnosed with a gynecologic malignancy within 3 years, with an incidence of 1.1 malignancies per 1000 person-years. Cancer incidence increased with age at the time of UAE: short-term malignancy diagnoses were made in 1 in 377 women aged 45 to 54 years, and 1 in 79 women aged 55 to 64 years. In the year before UAE, 28% (4311 of 15 362) of women without cancer, and 23% (5 of 22) of women diagnosed with uterine cancer had preprocedural endometrial sampling. Conclusion: These data can inform risk/benefit counseling and shared decision-making regarding UAE and its alternatives. Short-term malignancies after UAE highlight the importance of preprocedure evaluation in symptomatic women and women with age-related risk.
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INTRODUCTION: In the United States, almost 1 in 5 women are affected by sexual assault and may face particular challenges when it comes to obstetric and gynecologic care. This study examines providers’ knowledge, comfort level, and barriers to screening patients for a history of sexual violence. METHODS: We conducted an anonymous computer-based survey which was sent to all physicians (n=46) in an Obstetrics and Gynecology department at a tertiary academic medical center. RESULTS: Our sample included 18 faculty members and 18 resident physicians for a response rate of 78%. The majority agree that it is important (97%) and that it is part of their role (81%) to screen patients for a history of sexual violence. While the majority agree that they feel comfortable screening patients for a history of sexual violence (69%), only 44% screen at least half of the time. The majority report feeling comfortable modifying their physical exam techniques to meet the needs of a patient with a history of sexual violence (61%), but do not know how to connect patients with timely, accurate resources (75%) and have not received formal training in screening patients (67%), responding to a disclosure of violence (67%), or modifying physical exam techniques (75%). CONCLUSION: Most providers agree that screening for a history of sexual violence is important and is part of their role as obstetricians or gynecologists. However, less than half screen patients regularly. Additional training and education could improve this discrepancy and improve care for patients with a history of sexual violence.
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