Table of ContentsView AllTable of ContentsHome Remedies and LifestyleOver-the-Counter (OTC) TherapiesPrescription MedicationsSurgeries and Specialist-Driven ProceduresEffect on Black WomenAccess to CareNext in Uterine Fibroids GuideWhat Are Uterine Fibroids?
Table of ContentsView All
View All
Table of Contents
Home Remedies and Lifestyle
Over-the-Counter (OTC) Therapies
Prescription Medications
Surgeries and Specialist-Driven Procedures
Effect on Black Women
Access to Care
Next in Uterine Fibroids Guide
This article is part ofUterine Fibroids and Black Women, a destination in our Health Divide series.
There are many approaches to uterine fibroid management. Treatment for uterine fibroids can vary depending on the symptoms, size, number, and location of the fibroids. The desire to get pregnant is also a factor when deciding on treatment options.
Since fibroids are benign (noncancerous) tumors that rarely become malignant (cancerous), watchful waiting is the preferred management for fibroids that aren’t causing symptoms.
Most fibroids go unnoticed and disappear without treatment, but studies have shown that Black women are more likely than White women to have uterine fibroids, and are also more likely to have complications, longer hospitalization stays, and invasive procedures performed.
Doctors haven’t quite figured out why that is, but some studies have suggested that lack of access to care, gaps in socioeconomic status, and differences in treatment efficacy all play major roles. Based on multiple studies, implicit bias may also play a role in the types of intervention that black women are offered.
The goals of uterine fibroid treatment include:
This article discusses the treatment options for uterine fibroids, along with insights into the effect on Black women.
Home remedies and lifestyle changes to fight uterine fibroids have been around for quite some time.
This section describes the lifestyle factors that affect fibroid growth and development, as well as changes you can make to feel healthier and happier.
Reduce Stress
There is an abundance of research showing that chronic stress from racism can have a negative impact on the health of black women. Some preliminary research has linked high-stress levels with fibroid symptoms.
A high level of stress triggers excessive output of adrenal stress hormones, like cortisol. This can upset your hormonal balance, throwing offestrogenandprogesteronelevels.
Uterine fibroids thrive in chaotic hormonal environments, and growth in the size of uterine fibroids is seen during more stressful times of life.
Relaxation techniques—like yoga, massage, tai chi, and acupuncture—have been reported as effective means of managing stress and relieving pain as well.
Maintain a Healthy Weight
A large meta-analysis found that women with obesity were 19% to 26% more likely to have uterine fibroids, although the cause-and-effect link between the two is unknown.
Other research has looked at the relationship between body fat percentage and other measures related to obesity, and found that higher values for these measures were associated with about three to eight times higher risk of developing fibroids.
Lower Blood Pressure
Studies suggest that the presence of uterine fibroids is associated with hypertension (increased blood pressure), and the prevalence of hypertension in women with uterine fibroids has been shown to be as high as 40 percent.
Lowering your blood pressure may help your fibroids, and improves overall health.
Limit Red Meat Intake
High red meat intake has been associated with higher fibroid prevalence, but the causal link between the two is unknown.
Health professionals suggest limiting red meat consumption.
Avoid Processed Foods
Processed foods have lots of additives that are harmful to your health, especially if they are high in sugar, sodium, or calories.
Research has found that even occasionally consuming food additives increases your risk of developing fibroids and consuming them frequently multiplies the risk.Some doctors even encourage eating a special fibroid diet high in natural fruits and vegetables.
Stay Away From Soybeans
High soybean consumption is associated with a high risk of uterine fibroids because soybeans contain phytoestrogen, which can raise estrogen levels.
How To Shrink Fibroids
Vitamins and over-the-counter (OTC) pain medications—such as ibuprofen—are the most common nonprescription medications used to combat symptoms of uterine fibroids.
Nonsteroidal Anti-Inflammatory Drugs (NSAID)
The first line of defense against fibroid pain isnonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen ornaproxen—to help relieve mild pain.
NSAIDs are not as effective as oral birth control pills at limiting heavy menstrual bleeding in three months.
Vitamin D
Women with darker-pigmented skin tones are more likely to experience vitamin D deficiency, which some studies have associated with an increased risk of uterine fibroid development.
A 2019 study found that taking oralvitamin D supplementsresulted in a significant reduction in the size of uterine fibroids in premenopausal women.
The goal of prescription medications is to relieve pain, reduce menstrual blood flow, and, in some cases, shrink the growth of fibroids.
Birth Control Methods
Birth control pills are the most commonly prescribed medication to help control symptoms of heavy menstrual bleeding, especially for women who do not plan to get pregnant anytime soon.
Of note, IUDs and oral contraceptive pills do not shrink tumors. Women over 35 years old who smoke should not take certain oral contraceptive therapies.
GnRH Agonists (Lupron)
Lupron is not always well tolerated—possibly causing short-term symptoms of hot flashes and long-term symptoms of bone loss.
It is commonly used as a preoperative treatment to decrease the size of tumors before surgery or for women approaching menopause.
Iron Supplements
If you have symptoms of severe heavy menstrual bleeding, you may become anemic. You might be prescribed iron supplements to restore your depleted iron levels.
In severe cases, a blood transfusion may be needed. In most cases, this quickly corrects anemia.
With so many options out there, knowing which one is best for you can be daunting.
Finding a specialized OB-GYN who is proficient in performing these procedures can also be a challenge. This section will explain what’s out there for you, because knowing the options is half the battle.
Myomectomy
If you desire to have kids in the future, you may choose to have amyomectomy, a uterus-sparing operation to remove fibroids.
This is often a preferred choice for women of childbearing age, although it is likely to be a temporary fix because fibroids can grow back.
Black Women and MyomectomyBlack women receive myomectomy more than any other group. They are nearly seven times more likely to undergo this procedure.
Black Women and Myomectomy
Black women receive myomectomy more than any other group. They are nearly seven times more likely to undergo this procedure.
A myomectomy is often performed through a large abdominal incision, although a surgical technique that uses small incisions, calledlaparoscopy, is sometimes an option.
Laparoscopic myomectomy assesses and removes fibroids using long-handled instruments and a tiny camera—also known as a laparoscope—through a one-quarter-inch incision made in or near the belly button. This is also called a minimally invasive approach.
Hysterectomy
Surgical removal of the uterus via ahysterectomyprovides the most effective treatment against fibroids and eliminates any chance they will return, but it also eliminates your chance of getting pregnant.
An open hysterectomy means that a large abdominal incision is made to access the uterus. As with a myomectomy, a minimally invasive approach can sometimes be used, which decreases surgical scarring and recovery time.
Hysterectomy is usually the most definitive treatment for symptomatic women who want curative treatment and do not desire to have children in the future.
Fibroids are the leading reason for hysterectomies, accounting for nearly 40 percent of all hysterectomies performed annually in the United States.
Julie Bang / Verywell
Uterine Fibroid Embolization (UFE)
Misinformation or inadequate information about treatment for uterine fibroids illustrates how important it is to raise awareness about women’s health topics.
UFE is associated with clinically significant symptom relief in Black women and is considered a safe alternative for women looking for a less invasive, uterine-sparing treatment option. Efforts are needed to widen access to this nonsurgical treatment.
Magnetic Resonance-Guided Focused Ultrasound
Magnetic resonance-guided focused ultrasound (MRgFUS) uses MRIs to monitor troublesome fibroids and uses focused ultrasound waves to remove them.
MRgFUS is usually performed in an outpatient setting and is the only nonsurgical technique suitable for women wishing to preserve or enhance fertility.
Overall, this procedure has minimal side effects, and patients can usually go home the same day. Localized pain and some short-term heavy bleeding may occur.
How to Get Rid of Fibroids
Why Black women experience a disproportionate fibroid burden is a complicated question with a lot of potential answers.
What we know is that many Black women suffer from undertreatment, and that needs to change. More inclusive research is one way to accomplish that.
The scientific community has also made it known that there are multiple factors at play when it comes to the development, growth, and treatment of uterine fibroids. While research is limited, we know that risk factors like low vitamin D, obesity, genetic factors, higher rates of exposure to endocrine-disrupting chemicals like phthalates and BPA, stress, and racial discrimination all play a role in the development and growth of uterine fibroids.
And while there is a wide array of treatments available for fibroids, unfortunately not all women have the same options and access to care.
When you go to a healthcare provider, you expect to get all the information as a whole so you can make an informed decision for yourself and your future, but sometimes that is not the case.
A small study of 37 single, college-educated, and insured Black women found that patient-doctor interactions, support from social networks, fertility consequences, and fear of fibroid malignancy influenced their fibroid management decisions.
While it is impossible to generalize the results of a small study to an entire group of women, it highlights some potential targets that we may want to emphasize in clinical practice so that Black women are provided the equitable and effective treatment they need.
Lack of insurance, the normalization of pain, poor doctor-patient interactions, and non-inclusive research studies are obstacles to care that are not highlighted enough.
The propagation of Black pain myths in the U.S. healthcare system is especially troubling. Fibroid symptoms are likely underreported because some Black women may normalize their painful experiences. Even if they discuss their symptoms with their healthcare provider, it may be discounted or not addressed appropriately. Many women are raised to believe painful, heavy periods are just a part of life. By asking detailed questions about period symptoms, healthcare professionals can delegitimize pain myths and help avoid needless suffering and delayed treatment.
Also, access to care is largely dependent on where you live. Your insurance coverage varies based on geography, and rural areas tend to have fewer specialists than urban areas.
Black Health Coverage
Specialized care tends to be clustered around major cities. Certain areas are more rural in nature and may be devoid of specialty-trained OB-GYNs who feel comfortable performing certain procedures. If your OB-GYN has not been trained in certain minimally invasive or highly specialized techniques, those options may not be offered to you.
A Word From Verywell
Uterine fibroids are a common condition that many will experience during their life.
Word of mouth is a powerful tool to learn about new ideas from friends, family, or coworkers, but it is important to do your own research and consult healthcare professionals to get the most accurate and up-to-date information about the latest technologies and research.
Lack of proper health education has led many women to believe fibroid treatment myths that they hear or see. Even more, deep-seated medical mistrust and pain stigmatization have resulted in some Black women normalizing their pain and forgoing seeking treatment.
Increasing access to health insurance, and ultimately to treatment options, is just one of many solutions to this fibroid puzzle. No matter your situation, know that there are lifestyle changes or affordable treatment options out there for you; no woman should have to live in pain.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Williams ARW.Uterine fibroids - what’s new?.F1000Res. 2017;6:2109. doi:10.12688/f1000research.12172.1Wise LA, Laughlin-Tommaso SK.Epidemiology of uterine fibroids: from menarche to menopause.Clin Obstet Gynecol. 2016;59(1):2–24. doi:10.1097/GRF.0000000000000164Yang Q, Ciebiera M, Bariani MV, et al.Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment.Endocr Rev. 2022;43(4):678-719. doi:10.1210/endrev/bnab039Qin H, Lin Z, Vásquez E, Luan X, Guo F, Xu L.Association between obesity and the risk of uterine fibroids: a systematic review and meta-analysis.J Epidemiol Community Health. 2021;75(2):197-204. doi:10.1136/jech-2019-213364Sun K, Xie Y, Zhao N, Li Z.A case-control study of the relationship between visceral fat and development of uterine fibroids.Exp Ther Med. 2019;18(1):404-410. doi:10.3892/etm.2019.7575Kohi MP, Spies JB.Updates on uterine artery embolization.Semin Intervent Radiol. 2018;35(1):48–55. doi:10.1055/s-0038-1636521Donnez J, Dolmans MM.Uterine fibroid management: from the present to the future.Hum Reprod Update. 2016;22(6):665–686. doi:10.1093/humupd/dmw023Shen Y, Xu Q, Xu J, Ren ML, Cai YL.Environmental exposure and risk of uterine leiomyoma: an epidemiologic survey.Eur Rev Med Pharmacol Sci. 2013;17:3249–3256.Sohn GS, Cho S, Kim YM, et al.Current medical treatment of uterine fibroids.Obstet Gynecol Sci. 2018;61(2):192–201. doi:10.5468/ogs.2018.61.2.192Benaglia L, Cardellicchio L, Filippi F, et al.The rapid growth of fibroids during early pregnancy.PLoS One. 2014;9(1):e85933. doi:10.1371/journal.pone.0085933Sangkomkamhang US, Lumbiganon P, Pattanittum P.Progestogens or progestogen-releasing intrauterine systems for uterine fibroids (other than preoperative medical therapy).Cochrane Database Syst Rev. 2020;11(11):CD008994. doi:10.1002/14651858.CD008994.pub3De la Cruz MS, Buchanan EM.Uterine fibroids: diagnosis and treatment.Am Fam Physician. 2017;95(2):100-107.Eltoukhi HM, Modi MN, Weston M, Armstrong AY, Stewart EA.The health disparities of uterine fibroid tumors for African American women: a public health issue.Am J Obstet Gynecol. 2014;210(3):194-199. doi:10.1016/j.ajog.2013.08.008Sridhar D, Kohi MP.Updates on MR-guided focused ultrasound for symptomatic uterine fibroids.Semin Intervent Radiol. 2018;35(1):17-22. doi:10.1055/s-0038-1636516Boyd CA, Riall TS.Unexpected gynecologic findings during abdominal surgery.Curr Probl Surg. 2012;49(4):195–251. doi:10.1067/j.cpsurg.2011.12.002Additional ReadingFarris M, Bastianelli C, Rosato E, Brosens I, Benagiano G.Uterine fibroids: an update on current and emerging medical treatment options.Ther Clin Risk Manag. 2019;15:157–178. doi:10.2147/TCRM.S147318Parazzini F, Di Martino M, Candiani M, Viganò P.Dietary components and uterine leiomyomas: a review of published data.Nutr Cancer. 2015;67(4):569-579. doi:10.1080/01635581.2015.1015746
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Williams ARW.Uterine fibroids - what’s new?.F1000Res. 2017;6:2109. doi:10.12688/f1000research.12172.1Wise LA, Laughlin-Tommaso SK.Epidemiology of uterine fibroids: from menarche to menopause.Clin Obstet Gynecol. 2016;59(1):2–24. doi:10.1097/GRF.0000000000000164Yang Q, Ciebiera M, Bariani MV, et al.Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment.Endocr Rev. 2022;43(4):678-719. doi:10.1210/endrev/bnab039Qin H, Lin Z, Vásquez E, Luan X, Guo F, Xu L.Association between obesity and the risk of uterine fibroids: a systematic review and meta-analysis.J Epidemiol Community Health. 2021;75(2):197-204. doi:10.1136/jech-2019-213364Sun K, Xie Y, Zhao N, Li Z.A case-control study of the relationship between visceral fat and development of uterine fibroids.Exp Ther Med. 2019;18(1):404-410. doi:10.3892/etm.2019.7575Kohi MP, Spies JB.Updates on uterine artery embolization.Semin Intervent Radiol. 2018;35(1):48–55. doi:10.1055/s-0038-1636521Donnez J, Dolmans MM.Uterine fibroid management: from the present to the future.Hum Reprod Update. 2016;22(6):665–686. doi:10.1093/humupd/dmw023Shen Y, Xu Q, Xu J, Ren ML, Cai YL.Environmental exposure and risk of uterine leiomyoma: an epidemiologic survey.Eur Rev Med Pharmacol Sci. 2013;17:3249–3256.Sohn GS, Cho S, Kim YM, et al.Current medical treatment of uterine fibroids.Obstet Gynecol Sci. 2018;61(2):192–201. doi:10.5468/ogs.2018.61.2.192Benaglia L, Cardellicchio L, Filippi F, et al.The rapid growth of fibroids during early pregnancy.PLoS One. 2014;9(1):e85933. doi:10.1371/journal.pone.0085933Sangkomkamhang US, Lumbiganon P, Pattanittum P.Progestogens or progestogen-releasing intrauterine systems for uterine fibroids (other than preoperative medical therapy).Cochrane Database Syst Rev. 2020;11(11):CD008994. doi:10.1002/14651858.CD008994.pub3De la Cruz MS, Buchanan EM.Uterine fibroids: diagnosis and treatment.Am Fam Physician. 2017;95(2):100-107.Eltoukhi HM, Modi MN, Weston M, Armstrong AY, Stewart EA.The health disparities of uterine fibroid tumors for African American women: a public health issue.Am J Obstet Gynecol. 2014;210(3):194-199. doi:10.1016/j.ajog.2013.08.008Sridhar D, Kohi MP.Updates on MR-guided focused ultrasound for symptomatic uterine fibroids.Semin Intervent Radiol. 2018;35(1):17-22. doi:10.1055/s-0038-1636516Boyd CA, Riall TS.Unexpected gynecologic findings during abdominal surgery.Curr Probl Surg. 2012;49(4):195–251. doi:10.1067/j.cpsurg.2011.12.002Additional ReadingFarris M, Bastianelli C, Rosato E, Brosens I, Benagiano G.Uterine fibroids: an update on current and emerging medical treatment options.Ther Clin Risk Manag. 2019;15:157–178. doi:10.2147/TCRM.S147318Parazzini F, Di Martino M, Candiani M, Viganò P.Dietary components and uterine leiomyomas: a review of published data.Nutr Cancer. 2015;67(4):569-579. doi:10.1080/01635581.2015.1015746
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Williams ARW.Uterine fibroids - what’s new?.F1000Res. 2017;6:2109. doi:10.12688/f1000research.12172.1Wise LA, Laughlin-Tommaso SK.Epidemiology of uterine fibroids: from menarche to menopause.Clin Obstet Gynecol. 2016;59(1):2–24. doi:10.1097/GRF.0000000000000164Yang Q, Ciebiera M, Bariani MV, et al.Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment.Endocr Rev. 2022;43(4):678-719. doi:10.1210/endrev/bnab039Qin H, Lin Z, Vásquez E, Luan X, Guo F, Xu L.Association between obesity and the risk of uterine fibroids: a systematic review and meta-analysis.J Epidemiol Community Health. 2021;75(2):197-204. doi:10.1136/jech-2019-213364Sun K, Xie Y, Zhao N, Li Z.A case-control study of the relationship between visceral fat and development of uterine fibroids.Exp Ther Med. 2019;18(1):404-410. doi:10.3892/etm.2019.7575Kohi MP, Spies JB.Updates on uterine artery embolization.Semin Intervent Radiol. 2018;35(1):48–55. doi:10.1055/s-0038-1636521Donnez J, Dolmans MM.Uterine fibroid management: from the present to the future.Hum Reprod Update. 2016;22(6):665–686. doi:10.1093/humupd/dmw023Shen Y, Xu Q, Xu J, Ren ML, Cai YL.Environmental exposure and risk of uterine leiomyoma: an epidemiologic survey.Eur Rev Med Pharmacol Sci. 2013;17:3249–3256.Sohn GS, Cho S, Kim YM, et al.Current medical treatment of uterine fibroids.Obstet Gynecol Sci. 2018;61(2):192–201. doi:10.5468/ogs.2018.61.2.192Benaglia L, Cardellicchio L, Filippi F, et al.The rapid growth of fibroids during early pregnancy.PLoS One. 2014;9(1):e85933. doi:10.1371/journal.pone.0085933Sangkomkamhang US, Lumbiganon P, Pattanittum P.Progestogens or progestogen-releasing intrauterine systems for uterine fibroids (other than preoperative medical therapy).Cochrane Database Syst Rev. 2020;11(11):CD008994. doi:10.1002/14651858.CD008994.pub3De la Cruz MS, Buchanan EM.Uterine fibroids: diagnosis and treatment.Am Fam Physician. 2017;95(2):100-107.Eltoukhi HM, Modi MN, Weston M, Armstrong AY, Stewart EA.The health disparities of uterine fibroid tumors for African American women: a public health issue.Am J Obstet Gynecol. 2014;210(3):194-199. doi:10.1016/j.ajog.2013.08.008Sridhar D, Kohi MP.Updates on MR-guided focused ultrasound for symptomatic uterine fibroids.Semin Intervent Radiol. 2018;35(1):17-22. doi:10.1055/s-0038-1636516Boyd CA, Riall TS.Unexpected gynecologic findings during abdominal surgery.Curr Probl Surg. 2012;49(4):195–251. doi:10.1067/j.cpsurg.2011.12.002
Williams ARW.Uterine fibroids - what’s new?.F1000Res. 2017;6:2109. doi:10.12688/f1000research.12172.1
Wise LA, Laughlin-Tommaso SK.Epidemiology of uterine fibroids: from menarche to menopause.Clin Obstet Gynecol. 2016;59(1):2–24. doi:10.1097/GRF.0000000000000164
Yang Q, Ciebiera M, Bariani MV, et al.Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment.Endocr Rev. 2022;43(4):678-719. doi:10.1210/endrev/bnab039
Qin H, Lin Z, Vásquez E, Luan X, Guo F, Xu L.Association between obesity and the risk of uterine fibroids: a systematic review and meta-analysis.J Epidemiol Community Health. 2021;75(2):197-204. doi:10.1136/jech-2019-213364
Sun K, Xie Y, Zhao N, Li Z.A case-control study of the relationship between visceral fat and development of uterine fibroids.Exp Ther Med. 2019;18(1):404-410. doi:10.3892/etm.2019.7575
Kohi MP, Spies JB.Updates on uterine artery embolization.Semin Intervent Radiol. 2018;35(1):48–55. doi:10.1055/s-0038-1636521
Donnez J, Dolmans MM.Uterine fibroid management: from the present to the future.Hum Reprod Update. 2016;22(6):665–686. doi:10.1093/humupd/dmw023
Shen Y, Xu Q, Xu J, Ren ML, Cai YL.Environmental exposure and risk of uterine leiomyoma: an epidemiologic survey.Eur Rev Med Pharmacol Sci. 2013;17:3249–3256.
Sohn GS, Cho S, Kim YM, et al.Current medical treatment of uterine fibroids.Obstet Gynecol Sci. 2018;61(2):192–201. doi:10.5468/ogs.2018.61.2.192
Benaglia L, Cardellicchio L, Filippi F, et al.The rapid growth of fibroids during early pregnancy.PLoS One. 2014;9(1):e85933. doi:10.1371/journal.pone.0085933
Sangkomkamhang US, Lumbiganon P, Pattanittum P.Progestogens or progestogen-releasing intrauterine systems for uterine fibroids (other than preoperative medical therapy).Cochrane Database Syst Rev. 2020;11(11):CD008994. doi:10.1002/14651858.CD008994.pub3
De la Cruz MS, Buchanan EM.Uterine fibroids: diagnosis and treatment.Am Fam Physician. 2017;95(2):100-107.
Eltoukhi HM, Modi MN, Weston M, Armstrong AY, Stewart EA.The health disparities of uterine fibroid tumors for African American women: a public health issue.Am J Obstet Gynecol. 2014;210(3):194-199. doi:10.1016/j.ajog.2013.08.008
Sridhar D, Kohi MP.Updates on MR-guided focused ultrasound for symptomatic uterine fibroids.Semin Intervent Radiol. 2018;35(1):17-22. doi:10.1055/s-0038-1636516
Boyd CA, Riall TS.Unexpected gynecologic findings during abdominal surgery.Curr Probl Surg. 2012;49(4):195–251. doi:10.1067/j.cpsurg.2011.12.002
Farris M, Bastianelli C, Rosato E, Brosens I, Benagiano G.Uterine fibroids: an update on current and emerging medical treatment options.Ther Clin Risk Manag. 2019;15:157–178. doi:10.2147/TCRM.S147318Parazzini F, Di Martino M, Candiani M, Viganò P.Dietary components and uterine leiomyomas: a review of published data.Nutr Cancer. 2015;67(4):569-579. doi:10.1080/01635581.2015.1015746
Farris M, Bastianelli C, Rosato E, Brosens I, Benagiano G.Uterine fibroids: an update on current and emerging medical treatment options.Ther Clin Risk Manag. 2019;15:157–178. doi:10.2147/TCRM.S147318
Parazzini F, Di Martino M, Candiani M, Viganò P.Dietary components and uterine leiomyomas: a review of published data.Nutr Cancer. 2015;67(4):569-579. doi:10.1080/01635581.2015.1015746
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