INTRODUCTION:
Uterine fibroids commonly cause pelvic symptoms, abnormal uterine bleeding, and urinary symptoms. According to past UFS data analysis, Asian women report significantly lower symptoms compared to Caucasians. Etiology of this difference has not been studied and may impact early detection and treatment for Asian women. Differences in fibroid burden, clinical risk factors and parity between Asians and Caucasians may correlate to the difference in UFS scores. We examined correlations between race and fibroid symptom severity using MRI and patient clinical data.
METHODS:
A retrospective cohort study (2013–2016) of Stanford Fibroid Clinic patients identified Caucasians (n=146) and Asians (n=123) with completed UFS surveys and pelvic MRIs. UFS scores and subscores, MRI data, clinical risk factors, and parity were correlated to race. Data were analyzed using Pearson's T-test and Chi squared analysis.
RESULTS:
Asians had significantly lower BMI values (P=5.31e-09) and were more likely nonsmokers (P=.003) vs Caucasians. Asians were less likely to report pain (P=.010), urinary frequency (P=.032) and urinary stress incontinence (P=.045). There was no significant difference in fibroid burden between groups (P=.618).
CONCLUSION:
Significant differences in BMI and smoking history may contribute to observed UFS score differences between Asian and Caucasian women, as both have been correlated to increased symptom severity of uterine fibroids in past studies. Conversely, fibroid burden and parity are not associated with the differential symptom experience. Further study of cultural and social factors, and biochemical and inflammatory markers between Asian and Caucasian women with uterine fibroids is necessary to interpret the observed symptom differences.
Introduction: Uterine fibroids are prevalent in reproductive-age Asian women and can have a severe impact on health due to heavy bleeding, pelvic pain, and psychosocial harm. Current treatment, ranging from expectant management to hysterectomy, is aimed at symptom alleviation. Therefore, it is crucial for providers to accurately gauge symptom impact to determine appropriate treatments. A recent study reported differential symptom scores between Asian and Caucasian women treated at the Stanford Fibroid Center (SFC).1 In this pilot study, we aim to explore potential etiologies contributing to this finding by comparing fibroid size and location, clinical factors, and surveying sociocultural factors.
Methods: We utilized a mixed methods approach to uncover potential associations to differential Uterine Fibroid Symptom and Health-Related Quality of Life Symptom Severity Scores (UFS-QoL SSS) between Asian and Caucasian patients at SFC. We quantitatively analyzed fibroid imaging data and clinical risk factors from this cohort and qualitatively compared semi-structured interviews in a representative sub-sample.
Results: We found no significant difference in fibroid size or location between groups. However, Asians had significantly lower body mass index (P < 0.0001) and were more likely non-smokers (P = 0.0037) compared to Caucasians. After adjusting for these and other risk factors, pretreatment UFS-QoL SSS in Asian patients were still significantly lower (P < 0.0001). Qualitative interviews with Asian and Caucasian interviewees demonstrated comparable symptom experiences and quality of life, but more Asian participants described a negative impact from family and friends, less access to and distrust of medical providers, and pursuit of alternative therapies for their fibroids.
Conclusion: These findings suggest that the UFS-QoL questionnaire may be insufficient for capturing symptom burden in patients of different races. Further understanding on how the above factors modulate symptom reporting is warranted to help design appropriate fibroid treatment recommendations for diverse populations.
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