Presence of Fibroids on Transvaginal Ultrasonography in a Community-Based, Diverse Cohort of 996 Reproductive-Age Female Participants

Abstract

ImportanceFibroids are benign uterine tumors that can cause significant morbidity. Knowledge on fibroid prevalence, especially in the asymptomatic population and in Asian and Hispanic or Latina individuals, is limited, and a better understanding of affected groups will improve timely diagnosis and motivate appropriate recruitment in clinical trials to reduce health disparities.ObjectiveTo estimate the prevalence of fibroids in a diverse cohort of female individuals.Design, Setting, and ParticipantsThis cross-sectional study included female individuals not seeking treatment for fertility or other conditions who were prospectively recruited in an academic medical center in San Francisco, California. Effort was made to recruit an equal proportion of participants from 4 large racial and ethnic groups in the United States (Asian-Chinese, Black or African American, Hispanic or Latina, and White) and across 4 equal age groups between 25 and 45 years. All participants reported regular menses (21-35 days), had not used estrogen- or progestin-containing medications in the 3 months prior to enrollment, and denied history of pelvic surgery. The assessment of ultrasonography results was part of an ongoing longitudinal cohort, with initial recruitment from October 2006 to September 2012. Data analysis was performed in April to September 2022.Main Outcomes and MeasuresFibroid presence and burden as assessed by transvaginal ultrasonography.ResultsA total of 996 female participants were included in the analysis, including 229 (23.0%) Asian-Chinese, 249 (25.0%) Black or African American, 237 (23.8%) Hispanic or Latina, and 281 (28.2%) White individuals. Mean (SD) age was 34.8 (5.7) years in Asian-Chinese participants, 35.4 (6.1) years in Black or African American participants, 34.8 (5.3) years in Hispanic or Latina participants, and 35.3 (5.0) years in White participants. Fibroids were present in 21.8% (95% CI, 16.7%-27.8%) of Asian-Chinese participants, 35.7% (95% CI, 29.8%-42.0%) of Black or African American participants, 12.7% (95% CI, 8.7%-17.6%) of Hispanic or Latina participants, and 10.7% (95% CI, 7.3%-14.9%) of White participants. Black or African American and Asian-Chinese participants were more likely to have fibroids than White participants (Black or African American: adjusted odds ratio [OR], 4.72 [95% CI, 2.72-8.18]; P < .001; Asian-Chinese: adjusted OR, 3.35 [95% CI, 1.95-5.76]; P < .001). In those with fibroids, the proportion with multiple fibroids were 48.3% in Black or African American participants, 33.3% in White participants, 33.3% in Hispanic or Latina participants, and 26.0% in Asian-Chinese participants (P = .06). The largest mean (SD) fibroid diameter was 3.9 (1.9) cm in Black or African American participants, 3.2 (1.6) cm in Asian-Chinese participants, 3.2 (1.6) cm in White participants, and 3.0 (1.4) cm in Hispanic or Latina participants (P = .03).Conclusions and RelevanceIn this study of female participants in a nonclinical setting, Black or African American and Asian-Chinese participants were disproportionately affected by uterine fibroids. Hispanic or Latina participants had similar fibroid burden to White participants.

Fibroid Prevalence—Still So Much to Learn

“…Despite these limitations, the study by Huang et al provides estimates of fibroid prevalence in 2 populations, Asian-Chinese and Hispanic, that are largely missing from the literature. There is an approximately 10-year earlier onset of fibroids in Black individuals compared with White individuals.…”

“…The report from Huang et al elsewhere in JAMA Network Open used a community-based cohort with systematic ultrasonographic screening to document the high fibroid prevalence in reproductive-aged participants (20%), the 2- to 3-fold higher prevalence of fibroids in Black or Asian-Chinese individuals compared with White or Hispanic individuals, and the early age of fibroid onset in both Black and Asian-Chinese participants. In the context of fibroid research, estimates of fibroid prevalence in a diverse community sample are limited.…”

“…Most studies rely on suboptimal study designs, including secondary analysis of studies designed for other outcomes. The study by Huang et al used ultrasonographic imaging for diagnosis, but the data were collected for a different hypothesis, which may lead to bias. The eligibility criteria for the primary study excluded those using hormonal contraception and those with a history of pelvic surgery.…”

“…As a result, Black individuals have a greater disease burden due to more years of premenopausal hormonal stimulation of these tumors, resulting in larger size, more debilitating symptoms, and a greater need for surgical intervention . The data in the study by Huang et al suggest a similarly early onset in Asian-Chinese individuals. The reasons for differences in age of onset are not well understood but may be due to variation in environmental exposures and social determinants of health .…”

“…Research on fibroids and other female-specific conditions that vary by race and ethnicity have unique challenges given the impact of sex and race on access to quality health care . Huang and others note some of these challenges, including systemic racism and inequities in access to care, that result in delayed diagnosis of fibroids . This delay results in many people living with significant symptom burden without a clinical diagnosis.…”