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Lecturing in Johannesburg

A few weeks ago I was lecturing in Johannesburg on fibroid embolisation to gynaecologists where fibroid embolisation is gradually gaining acceptance in South Africa. This is, of course, very belated considering the procedure has been going since 1985 and accepted by the British and American Colleges since 2006.

Occasionally some fibroids die owing to defective blood supply but this is not common and in most cases fibroid masses will remain relatively unchanged after the menopause. Patients with fibroid masses should therefore be wary of delaying treatment in the hope that fibroid masses may shrink after the menopause.

The gynaecologists there were very receptive but there is no doubt that there is a struggle to get fibroid embolisation accepted and used by the gynaecologists and I think that the main problem, given the huge weight of evidence in favour of fibroid embolisation, is a conflict of interests ie interventional radiologists are not gynaecologists and yet they are carrying out a procedure which obviates the most common major surgical procedure carried out by gynaecologists which is hysterectomy for fibroids. There is therefore no specific incentive for gynaecologists to refer patients to radiologists.

In the private sector, of course, they lose money and in addition the patient is passing to someone ostensibly outside their specific speciality although these days radiologists are increasingly involved with gynaecologists, not only because they perform transvaginal ultrasound scanning in patients with gynaecological diseases, but also the huge break-through in elucidating gynaecological pathology using magnetic resonance imaging which is of course a radiological tool interpreted and controlled by radiologists.

Anyway, hopefully fibroid embolisation will gain sway in South Africa as there is a huge potential demand for it because of the increased incidence of fibroids in African women where they tend to occur at an earlier age and where the disease is somewhat more aggressive.

While I was in South Africa I did note that it was particularly cold in the UK and I did feel sorry for you all.

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