Uterine fibroids (also called leiomyomas or leiomyomata) are monoclonal, benign, smooth muscle tumors of the myometrium, the muscular portion of the uterus. They are the most common female genitourinary system tumor. Although 40 percent of all women in the United States have symptomatic uterine fibroids, some studies indicate that as many as 70 percent of all women of reproductive age have these growths, and 80 percent of black women have uterine fibroids. Despite the availability of new treatments, they have been and remain the most common reason for hysterectomy.

Uterine fibroids cause significant morbidity, especially in premenopausal women. Among the symptoms are excessive menstrual bleeding, both in terms of volume and length of menstrual periods or bleeding between menses, resulting in anemia and fatigue; in some cases, large fibroids may cause pressure on the urinary bladder, resulting in frequent urination, or pressure on the rectum; and large fibroids may make a woman look pregnant. Fibroids also have an adverse affect on fertility, causing infertility or pregnancy loss. The traditional treatment of hysterectomy renders women infertile, so there has been a quest for better means of treating this condition.

Special Topics has analyzed the literature published about uterine fibroids within the last 10 years (1994 to 2004) and the last two years (2003 and 2004). The 20 most-cited papers in both these groups indicate a possible change in emphasis in treatments for uterine fibroids. The most-cited paper in the 10-year period is a survey of data on hysterectomy in the United States from 1988-1990. The #3 paper in this group is also on hysterectomy: a long-term health study of the effects of hysterectomy. The second most-cited paper in the group, however, is one of the seminal papers on a new, noninvasive treatment for uterine fibroids, uterine artery embolization (UAE), which uses synthetic microparticles to selectively block the uterine artery so that blood flow to the fibroids will be cut off, without affecting the normal supply of blood to healthy uterine tissue. During the 10-year period, among papers on treatment of the condition, there were the two papers on hysterectomy, plus seven papers on use of UAE in clinical trials, one on the use of mifepristone (RU-486), one on endometrial resection (surgery to remove the endometrium), and one on myomectomy (surgical removal of the fibroid itself) versus hysterectomy.

The more recent highly cited papers only include one on hysterectomy, and that one compares it with UAE. There are five papers on UAE, two on a newer technique that uses magnetic resonance imaging-guided ultrasound to destroy fibroids, and one on mifepristone treatment.

The etiology of these tumors remains unknown, and both sets of papers also include articles that focus on the possible genetic and biochemical mechanisms related to fibroid formation. The older group of papers, however, includes only one on gene expression, two on biochemistry of the tumors, three on hormone effects, one on pathogenesis, and one on toxicology. On the two-year list, there are more gene-expression papers (six), and more papers focusing on biochemistry, signal transduction, and cellular receptors (four in total). An interesting paper on epidemiology, focusing on the incidence of fibroids in black and white women, is the sixth most-cited in the two-year group.

Researchers in the field expect that the area that will be of the most interest to clinicians in the near future will be the maintenance of fertility after uterine fibroid treatment.

Methodology

To construct this database, papers were extracted based on title- and author-supplied keywords for uterine fibroids. The keywords used were as follows: 

fibroid*
-or- 
myoma*
-or-
leiomyoma*
-or-
leiomyomata*
-or- 
benign gynecological tumor*

The baseline time span for this database is 1994-2004 (sixth bimonthly, 11-year period). The resulting database contained 4,686 (11 years) and  954 (2 years - January 1, 2004-December 31, 2004) papers; 14,330 authors; 80 countries; 737 journals; and 2,985 institutions.

Rankings

Once the database was in place, it was used to generate the lists of top 20 papers (two, and ten years periods), authors, journals, institutions, and nations, covering a time span of 1994-2004 (sixth bimonthly, 11-year period).

The top 20 papers are ranked according to total cites. Rankings for author, journal, institution, and country are listed in three ways: according to total cites, total papers, and total cites/paper. The paper thresholds and corresponding percentages used to determine scientist, institution, country, and journal rankings according to total cites/paper, and total papers respectively are as follows:

Entity:	Scientists	Institutions	Countries	Journals
Thresholds:	8	26	7	12
Percentage:	1%	1%	50%	10%

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