Insight
When surgery spreads cancer: A silent killer in women’s health
By Daniela Schardinger
For decades, women’s health has been sidelined, underfunded, and overlooked. While progress is being made, some of the most serious threats to women’s health remain hidden in plain sight.
One of the biggest risks is something few women are ever warned about – the silent spread of undiagnosed cancer during routine gynecologic surgery.
Every year, millions of women undergo hysterectomies, myomectomies, and adnexal mass removals due to common uterine conditions – such as uterine fibroids (myomas), which affect 7 in 10 women and 8 in 10 women of colour, making them the leading cause of hysterectomy.
While these surgeries can be medically necessary, they carry an often-overlooked danger – one that can mean the difference between life and death.
Research shows that 1 in 350 women undergoing a hysterectomy or myomectomy has undiagnosed cancer, and for adnexal mass removals, that number is 1 in 100.
If these procedures are performed without proper containment, cancerous cells can spread, drastically lowering survival rates.
Despite these publicly recognised risks that led to hundreds of million-dollar lawsuits a decade ago, hospitals have been shockingly slow to adopt the safest surgical techniques, putting women at unnecessary risk.
The Risk No One Talks About
To minimise scarring and speed up recovery, most gynecologic surgeries are performed laparoscopically, using a technique that is called morcellation – to breaks down larger tissue to small pieces and removing them through a small incision.
When power morcellators were banned in 2014 due to their potential to spread undiagnosed cancer, many assumed the problem had been solved.
But instead of developing safer alternatives, surgeons simply switched to manual morcellation, often using simple bags that are not designed or approved for that use and rupture at alarmingly high rates.
Some hospitals still rely on non-FDA-cleared surgical bags that rupture up to 30 per cent of the time, while even common FDA-cleared containment systems have a 15 per cent failure rate.
This means that women undergoing these procedures are still at risk of cancerous cell spillage – a risk that could and should have been eliminated by now.
Uterine cancer is one of the slowest cancers to be detected, often remaining asymptomatic until later stages.
This makes the risk of undiagnosed malignancy during surgery particularly concerning.
Since current preoperative screenings are not always conclusive, it is imperative to use the safest possible containment techniques to prevent the spread of cancerous cells during gynecologic procedures.
In the U.S. alone, safer containment systems have the potential to protect 400,000 women annually from unnecessary cancer spread.
And it’s not just cancer that’s a concern.
Uncontained morcellation can also spread endometrial cells, potentially leading to or exacerbating endometriosis, a painful and often debilitating condition.
Even benign tissue, if dispersed in the abdominal cavity, can adhere to other organs, causing complications such as bowel obstructions, chronic pain, and diminished quality of life.
These risks are entirely preventable when the right containment tools are used – yet outdated practices continue, leaving women vulnerable to life-altering consequences.
As Dr. Vadim Morozov, MD, puts it:
“As a surgeon, I’ve seen firsthand the devastating consequences of uncontained morcellation. The risk is real, and it’s preventable. We wouldn’t operate with a ruptured glove – so why would we operate with a ruptured containment bag?”
Innovation Exists – So Why Aren’t We Using It?
The frustrating reality is that safer solutions already exist.
Companies have developed advanced double-wall containment systems cleared by the FDA and designed to significantly reduce the risk of surgical spillage, ensuring that even if an undiagnosed cancer is present, it won’t spread during surgery.
These advanced containment solutions offer a much-needed safety net, providing surgeons with a tool to minimise the risk of surgical spillage and enhance patient safety.
However, many hospitals still rely on outdated techniques that were neither designed nor cleared for this use.
They are not required to adopt improved systems, and there are no universal guidelines mandating best practices.
Some hospitals continue using cheaper bags that lack FDA approval for such procedures, while others forego containment altogether due to outdated surgical habits.
And all of this happens without the patient’s awareness, as hospitals are left to govern and monitor themselves.
This raises an urgent question: Why are hospitals not moving faster to protect women?
Regulatory bodies, OB-GYN associations and hospitals must catch up with the pace of innovation. If safer solutions exist, they should be the standard – not the exception.
A Call to Action: Stop Preventable Cancer and Endometriosis Spread in Surgery
Startups and innovators are already making strides in this space, developing better containment systems and safer gynecologic surgical techniques. But they can’t do it alone.
- Hospitals must prioritise adopting proven containment systems to eliminate surgical spillage risks.
- Regulatory bodies must issue clearer guidelines enforcing the use of safer techniques.
- Investors and global healthcare players must help scale innovations in this space.
Now, the question is: Will we step up and make it standard, or will we continue to let outdated practices be a silent killer of women?
It’s time for action. Women deserve better.
Daniela Schardinger is a recognised thought leader in women’s health innovation, dedicated to advancing FemTech, medical advancements, and global health initiatives. She serves on the Innovation Equity Steering Committee at the Bill & Melinda Gates Foundation and NIH, shaping policies that drive investment and innovation in women’s health.
Daniela has been a speaker and participant at World Economic Forum Innovator events and the Global Women’s Health Alliance meetings in New York, contributing to high-level discussions on the future of women’s healthcare.
She has been recognised as one of Forbes’ “Superwomen”, a 40 Under 40 honoree, recipient of the Visionary Award from the California State Senate, and named an Inspirational Woman by the LA Times.
Most recently, she was honored as the Woman of Influence 2025 Advocate of the Year by a U.S. Chamber of Commerce for her dedication to transforming women’s health globally.
Women are being urged to seek evidence-based advice and avoid menopause misinformation shared on social media.
A seminar co-hosted by the World Health Organization (WHO) mainly examined what is known about the cognitive effects of menopause and current research in the field worldwide.
Dr Nicole Jaff, a South African academic and certified menopause practitioner, said research into menopause and its effects was now at a peak.
She said: “There’s a lot of information out there.
“But I would say please look for the evidence-based information, not for the influencers and the misinformation, but those who are giving guidelines, who are giving information.”
Jaff highlighted research into cognitive changes during menopause and how some women experience brain fog, a term for difficulties with memory, concentration and clear thinking.
She said: “I’m very excited about the non-hormonal treatments that are now available, especially for women who could never take hormone therapy because of breast cancers and various cancers, who can now take it.
“I’m extremely excited about people who are standing up for evidence-based medicine, for science, who are actually fighting back against a lot of the social media and influencers who are not giving evidence-based information and making life very difficult for women because they think they should be forever young or buying this or buying that.”
Jaff advised women and healthcare workers to read new guidelines recently issued by the International Menopause Society. They are available free to download from its website.
The seminar also heard from Professor Aimee Spector, professor of clinical psychology of ageing at University College London.
She raised similar concerns about misinformation, particularly claims linking hormone replacement therapy, known as HRT, to dementia. Some claims suggest HRT reduces dementia risk, while others suggest it increases the risk.
Spector said: “I think there’s also lots of misinformation.
“And I think that there’s huge variations in how even professionals and doctors interpret this information.”
She was part of an international research team commissioned by the WHO last year to assess published studies on the issue.
The institutions involved also included the Global Brain Health Institute at Trinity College Dublin.
Spector said: “The first thing to say is that the quality of evidence was very low.
“Nine out of the 10 studies we looked at were observational, which means that you’re observing patterns over time. But you don’t necessarily know whether that’s due to the hormone therapy or not.
“Our overall recommendation was that there’s insufficient evidence for menopause hormone therapy in terms of either increasing or reducing the risk of dementia. In other words, we don’t know either way.”
Spector said women should therefore decide whether to use HRT to treat menopause symptoms rather than based on concerns about dementia.
She said: “It’s recommended for menopause symptoms, but it’s not recommended to reduce dementia. And I think a lot of people are saying that.”
The Menopause on the Brain webinar was part of an ongoing series hosted by the WHO and other global health agencies.
An endometriosis musical by two US writers will debut at the Edinburgh Festival Fringe in August.
“Endometriosis: The Musical” follows Jane, a woman trying to discover why she is living with chronic pain.
Maria Bartholdi and Kristin Stowell first developed the production for the 2022 Minnesota Fringe Festival.
The full show premiered at Theater in the Round in Minneapolis in 2025.
Stowell said the play drew on personal experience, although neither writer realised it at the time.
“So it’s like my goal to let women see themselves in this who are dealing with this and have a question they can bring back to their doctor,” she said.
“Like, could it be endometriosis?”
Bartholdi said she did not realise she might have the condition herself until after the play premiered.
“This show helped diagnose me, which I think is just one of the miraculous things that we hope this the show does for other people as well,” Bartholdi said.
Dr Wendy VanBuren, a radiologist at Mayo Clinic in Rochester, said she was a fan of the musical and its role in raising awareness of a common but underdiagnosed disease.
“Cells that are similar to but not identical to the cells that comprise the lining of the uterus, the inside of the uterus, are located outside the uterus,” said VanBuren.
“When they’re outside the uterus, there isn’t the right environment to deal with that. So basically, what you get is bleeding, and then you get inflammation.”
Roughly one in seven women live with the disease, and receiving a diagnosis can take nearly a decade.
Johnson & Johnson has offered an estimated US$5.5bn settlement covering about 76,000 claims that its talc products caused ovarian cancer.
The proposed agreement could end a contentious legal dispute over the company’s baby powder and other talc-based products that has lasted around a decade.
Johnson & Johnson said the settlement covers claims consolidated in a federal court in New Jersey and related cases in state court.
The claims represent nearly all the remaining talc cases against the US multinational, according to the company.
Johnson & Johnson has previously settled most claims alleging that its talc contained asbestos and caused mesothelioma.
Mesothelioma is a rare cancer affecting the lining of organs, most commonly the lungs, and is usually linked to asbestos exposure.
Law firms representing claimants confirmed the proposed deal, describing it as a good resolution after around 10 years of litigation.
The agreement must be accepted by 95 per cent of ovarian cancer claimants in state or federal court before it becomes final.
Erik Haas, vice-president of litigation at Johnson & Johnson, said the claims were “meritless” and that the company was willing to settle to bring the litigation to a close.
“While we are confident the company would have ultimately prevailed with further litigation, as it has in the vast majority of cases tried to date, this resolution allows the company to put this matter behind it and remain focused on its mission to develop medicines and devices that save lives,” Haas said.
The company expects to pay US$3bn in 2027, with further payments due in 2028.
The deal could be worth more, depending on how many people take part in the settlement.
Chris Seeger, a lawyer representing around 2,500 clients with talc claims who helped negotiate the agreement, said Johnson & Johnson could ultimately pay US$7bn or more.
The settlement assigns specific values to qualifying ovarian cancer claims but does not cap the company’s total payout.
“We got a fair settlement, and our clients are going to be happy with it,” Seeger said.
Johnson & Johnson reached the agreement after a series of court victories, including wins in individual trials and successful efforts to disqualify claimants’ lawyers from the litigation.
The company also secured court rulings against experts used by claimants to support their cases.
A federal judge last week questioned whether individual claimants could prove that talc had specifically caused their ovarian cancer.
Johnson & Johnson has consistently denied that its talc products caused cancer, maintaining that the products were safe and did not contain asbestos.
The company stopped selling talc-based baby powder in the US in 2020 and switched to a cornstarch-based product.
Litigation resumed in March 2025 after being paused for more than three years while Johnson & Johnson pursued a bankruptcy strategy known as the “Texas two step”.
The company filed three bankruptcies through a shell-company subsidiary in an attempt to settle the cases. Each bankruptcy was dismissed.
Before the bankruptcy attempts, Johnson & Johnson had a mixed record in talc trials.
These included a multibillion-dollar verdict for 22 women who said baby powder caused their ovarian cancer, alongside trials won by Johnson & Johnson and other verdicts later reduced on appeal.
Unlike the proposed bankruptcy settlements, the latest agreement applies only to existing claims and does not cover future lawsuits.
Seeger said excluding future claims made more money available for current claimants than the bankruptcy proposal and would allow all claims to be paid within 18 months rather than over more than a decade.
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