Amy Reed, MD, Morcellator Opponent, Dies of Uterine Cancer

May 25, 2017

Amy Reed, MD, PhD, an anesthesiologist whose laparoscopic hysterectomy in October 2013 called into question the safety of power morcellation, died Wednesday, May 24, at 44 years of age from uterine cancer.

Dr Reed, a mother of six, underwent the hysterectomy at Brigham and Women's Hospital in Boston, Massachusetts, to remove fibroid tumors. Power morcellation, intended to shred uterine tissue for removal through a laparoscopic incision, dispersed and upstaged an undiagnosed uterine leiomyosarcoma inside her abdomen.

While she battled through a series of surgeries and procedures, Dr Reed joined her husband, Hooman Noorchashm, MD, PhD, in a high-profile campaign to ban the use of the devices during gynecologic procedures and bolster oversight of all medical devices by the US Food and Drug Administration (FDA). The couple pressed for government investigations and legislation, coauthored articles, testified before the FDA, and shone a spotlight on women who had died after morcellation-upstaged occult uterine cancer.

The Noorchashm family. (Source: Courtesy of Hooman Noorchashm, MD)

Their efforts, spearheaded by Dr Noorchashm, achieved remarkable results in just a few years. In 2014, the FDA added a boxed warning to the label of power morcellators stating that they should not be used in most women who undergo hysterectomy or myomectomy for uterine fibroids. The agency estimated that 1 in 350 women who undergo such surgeries would develop an occult uterine sarcoma. One manufacturer of power morcellators withdrew them from the market, some hospitals dropped their use, and some insurers stopped paying for the procedure.

Not surprisingly, the use of power morcellators in minimally invasive hysterectomies has declined sharply since 2013. Many gynecologic surgeons, however, have argued that power morcellators should remain an available tool for women who would face a higher risk for injury or death in a traditional open-field hysterectomy or myomectomy.

In February, Dr Reed and her husband achieved a measure of vindication when a report from the Government Accountability Office (GAO) identified "serious gaps" in the FDA's system for spotting problems with medical devices such as power morcellators after they reach the marketplace. Although the first power morcellator was approved in 1991, nobody had reported an instance of the device dispersing occult cancer to the FDA until Dr Reed did in December 2013. Hospital executives and surgeons told the GAO that until the FDA ordered the boxed warning in 2014, they didn't feel obliged to report such incidents because the morcellators weren't malfunctioning, in their opinion, but were performing as intended.

In the professional debate about the benefits and risks of power morcellation, Dr Noorchashm, a heart surgeon, made his points in a steady stream of sharply worded and sometimes confrontational letters and emails to FDA officials, device manufacturers, politicians, and fellow clinicians. In comparison, Dr Reed was a milder advocate, although no less engaging.

Diana Zuckerman, PhD, president of the National Center for Health Research, recalled the impression Dr Reed made when the think tank honored her and Dr Noorchashm at an awards luncheon in 2015.

"She spoke without apparent anger or bitterness about what happened to her, which amazed me," Dr Zuckerman told Medscape Medical News. "I can't tell you what an impressive, gracious, wonderful woman she (was)."

A congressman who introduced legislation requiring physicians to report unsafe medical devices to the FDA credits the advocacy efforts of Dr Reed and her husband with savings women's lives.

"Dr Reed didn't ask for the situation she found herself in following a procedure in 2013," said Rep. Brian Fitzpatrick (R-Pa) in a news release, "but it was immediately evident to anyone who met her...that she was going to be a fighter, not only for herself, but others."

Determined to Beat the Odds

Dr Reed earned a PhD in immunology at the University of Pennsylvania and then an MD in 2005 from the institution's Perelman School of Medicine. She followed up with a postdoctoral fellowship in transplant immunology before completing her residency training in anesthesiology and a critical care fellowship at the Hospital of the University of Pennsylvania.

In 2011, Dr Reed joined the Department of Anesthesia, Critical Care and Pain Medicine at Beth Israel Deaconess Medical Center in Boston. It was there that Dr Reed treated victims of the 2013 Boston Marathon bombing along with the surviving bomber, Dzhokhar Tsarnaev.

She married Dr Noorchashm in 2001 and had the first three of their six children by the time she finished medical school. Their togetherness extended to research. They were coauthors of five published studies on immunology — Dr Noorchashm holds a PhD in that field, too.

In October 2013, about a year after the birth of their sixth child, Dr Reed had a hysterectomy to remove bothersome, but supposedly benign, uterine fibroids. She and Dr Noorchashm say her doctors recommended a laparoscopic as opposed to an open-field operation, but did not mention the use of a power morcellator.

Shortly after the operation, Dr Reed learned that she had a uterine leiomyosarcoma and that morcellation had advanced it to stage IV. She underwent cytoreduction and hypothermic intraperiotoneal chemotherapy followed by six rounds of systemic chemotherapy. MRI and CT scans indicated she was cancer free.

She and her family moved from Needham, Massachusetts, to Yardley, Pennsylvania, and by the end of 2014, she had recovered well enough to start working part time at the Hospital of the University of Pennsylvania. However, the leiomyosarcoma still lurked in her body, requiring a surgery to remove a tumor behind her left kidney in February 2015, with radiation treatment afterwards. More metastasis and more procedures, some experimental, followed.

"We all knew the odds were against her," said Dr Zuckerman, "but Hooman and Amy were both determined to beat the odds. They made it seem possible."

The end almost came in April when Dr Reed went into pulseless electrical activity cardiac arrest. As Dr Noorchashm described it in an email to media outlets, an inoperable abdominal tumor of hers bled internally and enlarged, pressing against the vena cava and cutting off blood return to the heart. Dr Reed's heart recovered after the tumor ruptured.

Dr Reed remained hospitalized until May 19, when she was discharged to go home and receive hospice care, Dr Noorchashm said in an email announcement that resembled a eulogy.

He wrote that what mattered to Dr Reed more than dying "is how we live, what we choose to think about, learn and do, the magnitude of our commitments and focus, who our friends are and what mandates of ethics and integrity guide us...in this life.

"Those are the principles by which Amy has lived a life of passion, accomplishment and love for all those she's touched."

In an interview with Medscape Medical News in 2015, Dr Reed described how she dealt with her children's anxiety about her health.

"They ask you questions like, 'Are you going to die?' " Dr Reed said. "I say, 'Well, everybody dies. I feel okay today.'

"They say, 'Is the cancer going to come back?' I say, 'I hope not. If it does, we'll deal with it.'

"You don't go down all those horrible, what-if pathways with the kids. And I don't think we should do that as adults.

"Look at what's in front of you today."

Follow Robert Lowes on Twitter @LowesRobert

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