In Sweden, thirty-three women have been victims of "mistaken" uterine ablation, after receiving a wrong diagnosis. Dr. Samuel Salama, obstetrician-gynecologist, sheds light on this case.

 In Sweden, nearly thirty-three women underwent unjustified hysterectomies after they developed precancerous changes in their cervix. How can such a medical error be explained? And in which cases should a hysterectomy (really) be performed? Answers from Dr. Samuel Salama, obstetrician-gynecologist

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33 unjustified preventive hysterectomies

On Tuesday, October 22, Uppsala University Hospital admitted to having operated "by mistake" on 33 women between 2023 and 2024, who had cellular changes that were precursors to uterine cancer.

The medical team actually encouraged women to undergo a "preventive hysterectomy" - that is, a surgical removal of the uterus - when it was not necessary.

" We deeply regret what happened. Removing the uterus is a major operation with serious and irreversible consequences," Johan Lugnegård, the hospital's chief physician, said in a statement. " We apologize to the women affected."

The women, aged between 38 and 85, had fortunately " finished childbearing," Gudlaug Sverrisdottir, the hospital's director of women's health care, told the Swedish newspaper Läkartidningen .

However, the moral and physical damage remains: the diagnosis made was wrong and none of these surgical interventions were justified.

The hospital warned the victims of its mistake

A rather rare occurrence in this type of case: it was the hospital structure that decided to sound the alarm, after noting an unexplained increase in the number of diagnoses of this type.

" We were too strict in our assessments […] which led to systematic overdiagnosis," acknowledges Tommie Olofsson, head of the university laboratory at the establishment.

The hospital also assured that it would "financially compensate" the thirty-three women concerned.

How can such an incident be explained?

According to Dr. Samuel Salama, obstetrician-gynecologist in Neuilly-sur-Seine, there are several things to distinguish.

" In this case, the indication of the anomalies seems correct, but it is the diagnosis that seems wrong. In fact, at the precancerous stage of the cervix, the uterus should not be removed. In the case of mild dysplasia (development of abnormal cells on the surface of the cervix), simple monitoring is necessary, and in the case of severe dysplasia, part of the uterus must be removed. It is therefore only in the case where cancer is proven that surgery should be performed. There is no other possible alternative," confirms the doctor.

But to diagnose cervical cancer, a biopsy must first be performed (a test that involves taking a sample of tissue from the cervix).

" The samples must be analyzed under a microscope, by staining the cells. However, within the Uppsala University Hospital, the mystery remains. Did a single person make a mistake when carrying out this analysis? Or did all the doctors decide on the operations? What is certain is that in France the decision to intervene (or not) is collective: multidisciplinary consultation meetings are held to measure the benefit-risk balance of each operation," assures Dr Samuel Salama.

The doctor also adds that each case is unique. A young woman with cervical cancer, for example, may be reluctant to have the operation (because it would compromise her plans for motherhood).

" In this case, of course, the operation can be a subject, and we take the time to discuss it," he says.

Removing a uterus is never trivial

Dr Samuel Salama would like to point out that there are many possible alternatives to surgery, particularly for treating begign pathologies (fibroids, polyps, abnormal adhesions of the mucosal surfaces, etc.):

• embolization (which consists of injecting a solid or liquid agent into an artery or vein in order to occlude a vascular area. For example, in the case of a fibroid, it will involute, deprived of vascularization).

• taking medication:

• or even hysteroscopy.

If these alternatives are to be considered, it is because removing a uterus is never trivial.

" A woman may have a bad experience with this operation and even develop depressive symptoms afterwards. It is therefore necessary to take the time to think about this intervention... and also to remember that a healthy uterus is not removed for X or Y reason! " He concludes.