Largest US insurer tightens hysterectomy guidelines amid cancer fears

The U.S.’s largest health insurer has announced it is to place stricter controls on its coverage of hysterectomies amid ongoing concerns that a once popular device used in laparoscopic surgeries can spread undetected cancer.

UnitedHealth Group said that from April 6, it would require physicians to obtain authorization before carrying out certain types of the procedure, namely laparoscopic “keyhole” surgeries and the removal of the uterus via the abdomen. These types of hysterectomies will not be approved unless deemed to be medically necessary, the insurer said in an update to its reimbursement guidelines.

The company, which provides health coverage for 70 million Americans, said its new stance was based on recommendations from the American Congress of Obstetricians and Gynecologists (ACOG), which concluded that vaginal hysterectomies should be favored over other types of the procedure as they are associated with better outcomes and fewer complications. It also comes amid concerns over the link between a surgical tool used in laparoscopic surgery and the spread of cancerous tissue.

A hysterectomy is a procedure in which a woman's uterus is removed for reasons ranging from fibroids or endometriosis to chronic pelvic pain, and is one of the most frequently performed surgeries in the U.S. Based on reports from the early 2000s, the U.S. Centers for Disease Control say around 600,000 hysterectomies are performed every year in the U.S.

The uterus can be removed through the vagina or abdomen, the later being associated with a larger incision and longer recovery time.

Surgeons sometimes use laparoscopic tools to allow for a less invasive operation that involves only a few small incisions. The move in UnitedHealth’s policy comes after research suggested a link between laparoscopic morcellators — once popular devices used in keyhole surgeries to cut up tissue — and cancer.

Scientists have said that the surgical devices can leave behind bits of undiagnosed malignant tissue that grow into new tumors.

The U.S. Food and Drug Administration (FDA) issued an advisory last April recommending that surgeons avoid the use of surgical morcellators in hysterectomies as a result of evidence that the technique could spread cancerous tissue. It issued a stronger warning in November, saying morcellators should not be used in the “vast majority” of cases.

The ACOG has likewise warned against their use, suggesting the device should not be a first or even second choice for most women. The group said vaginal operations allow women to leave the hospital just as quickly and don't cost nearly as much.

Al Jazeera and wire services