TOPLINE:

The annual rate of radical hysterectomies performed by gynecologic oncologists in the US declined significantly from 4.5 to 1.5 cases per oncologist between 2004 and 2020, despite the workforce growing from 571 to 1178 specialists.

METHODOLOGY:

• Researchers conducted a repeated cross-sectional study using data from the National Cancer Database, CDC’s United States Cancer Statistics, and published gynecologic oncologist workforce data from 2004 to 2020.
• Analysis included 217,366 newly diagnosed cervical cancer cases, with 166,779 (76.7%) identified in the National Cancer Database, comprising 92,731 (42.6%) early-stage, 77,704 (35.7%) locoregional, 29,796 (13.7%) advanced, and 13,147 (6.0%) unknown-stage cases.
• Investigators estimated stage-specific rates of radical hysterectomy and stage distribution from the National Cancer Database, then multiplied these rates by CDC’s national estimates to determine annual case counts.
• Annual radical hysterectomy rates per gynecologic oncologist were calculated by dividing the national case count by the number of practicing specialists each year.

TAKEAWAY:

• The number of practicing gynecologic oncologists increased significantly from 571 to 1178 over the study period, with an average increase of 45.7 oncologists per year (95% CI, 40.4-51.0).
• The annual count of radical hysterectomies declined by 1.9% per year (95% CI, 1.3-2.5), decreasing from 2570 in 2004 to 1840 in 2020 (absolute difference, -730; 95% CI, -1051 to -411).
• According to the researchers, the rate of radical hysterectomies per gynecologic oncologist showed a significant decline of 6.9% per year (95% CI, 6.4-7.5), corresponding to a drop from 4.5 to 1.5 cases per oncologist annually.
• No significant temporal trend was observed in the number of early-stage cervical cancer cases diagnosed from 2004 to 2020 (average annual percentage change, -0.2; 95% CI, -0.8 to 0.4).

IN PRACTICE:

“The increasing rarity of radical hysterectomy may pose a challenge to those seeking to acquire and maintain competency in this complex operation….The rarity of radical hysterectomy for cervical cancer may justify efforts to centralize these procedures among high-volume surgeons,” wrote the authors of the study.

SOURCE:

The study was led by Alexander Melamed, MPH, MD, Meigs Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

The study was limited by its reliance on administrative data lacking surgeon-level information, preventing analysis of case distribution among individual surgeons. The authors of the study noted that high case volume of other complex oncologic procedures, including radical hysterectomy for other indications, might mitigate the effect of declining rates for cervical cancer cases.

DISCLOSURES:

Melamed disclosed receiving consulting fees from Axena Health, Inc., and grants from the Department of Defense and National Institutes of Health. The other authors reported having no potential conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.