About five years ago, when Cindy Lee learned she had precancerous cells in the lining of her uterus that could become endometrial cancer, a lot of things went through her mind.
She had lost her father and two sisters to cancer at a relatively young age, but the standard treatment for what she had was a hysterectomy, which her health might not allow.
“I’m high risk as far as surgery,” said Lee, 52, of Augusta. “I have a lot of problems with my lungs, I smoke, I’m a diabetic. I just had so many health problems, and I didn’t know if I could make it through that.”
Instead, through Georgia Health Sciences University Cancer Center, she was offered an alternative – an intrauterine device that releases small amounts of a contraceptive progestin mixture. Five years later, she is fine without the surgery.
Lee is one of about 15 women who had an early-stage form of endometrial cancer or precancerous changes who were also poor candidates for surgery. They were offered the alternative treatment and then followed for two years.
The progestin was to act on the hormone-driven tumor cells, said Dr. Sharad Ghamande, the director of the multidisciplinary gynecologic cancer team at the university’s cancer center.
“It reverses the cancer or precancerous changes and moreover prevents the development of other malignancies,” he said.
Severe obesity often puts patients at higher risk from surgery but also makes them at high risk for the cancer, Ghamande said.
“In fact, that’s one of the biggest risk factors for endometrial cancer,” he said.
Estrogen produced by the excess fat helps increase the risk, and those with a body mass index higher than 30, considered obese, have three times the risk, said Dr. Cinar Aksu, a fellow in gynecologic oncology at the cancer center.
The average BMI for patients in the GHSU study was 46.2; 40 and over is considered severely obese. Many also had other factors such as diabetes that put them at higher risk for surgery and post-surgical complications such as poor wound healing, Ghamande said.
“These are high-risk people that you are trying not to do surgery on just because of the risk associated with the surgery,” Aksu said.
Also of great significance was the cost difference between an outpatient procedure to place the IUD and surgery, which, depending on the way it is performed, saves $10,225 to $28,039 per case.
“It’s a tremendous cost difference,” Aksu said, both for the hospital and potentially for society in less time that is lost at work and other savings, plus potentially fewer complications for the patient.
The GHSU researchers presented the study at an international conference this month but are hoping to move on to a much larger study to validate the results, Ghamande said.
The early results are promising, Ghamande said.
“The hope is to make more people aware that you don’t necessarily have to be aggressive and operate on this patient,” he said. “There is a very nice alternative.”