Uterine Fibroid Recurrence: Analyzing Racial Disparities and Associated Risk Factors

INTRODUCTION: Uterine fibroids (UFs) represent the most frequently diagnosed tumors among women of childbearing age. Data on fibroid recurrence rates in the general population is limited, and risk factors remain poorly defined. Understanding uterine fibroid recurrence is crucial as it constitutes a significant healthcare burden, associated morbidity, and potential disparities across racial and ethnic groups given the known racial disparity in UF incidence, with Black individuals having a two- to threefold increased risk of UF compared to White counterparts. OBJECTIVE: This study aims to investigate racial disparities among rates of UF recurrence and identify additional risk factors for UF recurrence. METHODS: This was a retrospective EHR-based cohort study (IRB #22-00924) of patients at risk of UF ages 16–50, without a UF ICD-10 code or surgical intervention as of 8/1/2016. We identified patients with a UF ICD-10 code during the observation period who underwent either a laparoscopy, open, robotic, hysteroscopic (HSC) myomectomy and/or uterine ablation. UF recurrence was defined as any UF symptom ICD-10 code or UF ICD-10 more than 1 year after intervention. Additional potential risk factors based on prior literature (age, parity, hormonal contraceptive use, hypertension, type 2 diabetes mellitus [T2DM]) were gathered from structured EHR data. Wilcoxon rank-sum test, Pearson’s chi-squared test, and logistic regressions were performed to investigate the relation between recurrence and potential risk factors. RESULTS: In our cohort, the UF recurrence rate was 44% (Table 1). While not statistically significant, Black patients had an increased risk of UF recurrence compared to non-Hispanic (NH) White patients (40% vs. 28%, p=0.34). NH Black patients were diagnosed earlier (median=36 [IQR 32–41]), compared to other groups (Table 2). In our cohort, the median time to recurrent symptoms was 661 days (IQR= 465, 892). Among Black patients, the median time to recurrence was 683 days (IQR= 474,847) compared to 709 days (IQR= 452, 925) among White patients (p=0.9). Hypertension, T2DM, and parity at diagnosis were not associated with an increased risk of recurrence (p=0.28, p=0.11, and p=0.3). Any hormonal contraceptive (HC) use prior to intervention was associated with decreased risk of recurrence (OR= 0.52, 95% CI 0.31–0.85). There was no difference in recurrence rate among surgical subtypes; however, uterine ablation had the lowest recurrence rate at 27.9% compared to the other interventions (43.5–52.9%, p=0.13) (Figure 1). CONCLUSIONS: We observed a UF recurrence rate of 44% consistent with previous literature (33–46%). While not statistically significant, Black patients exhibited a higher recurrence risk and shorter time to recurrence, suggesting shorter periods of symptom relief, a need for more timely interventions, and closer monitoring of symptoms. Prior use of HCs was associated with reduced recurrence consistent with prior literature and treatment guidelines for UF. While T2DM and hypertension were associated with recurrence in prior studies, we did not observe this association, potentially due to a younger patient population in our cohort. Future studies should further investigate these risk factors and their impact on UF recurrence.