 If you randomly select a group of women and ultrasound their uterus, the majority of them have fibroid tumors by age 50. And by most, I mean more than 80% of black women and about nearly 70% of white women. Half of white women already have fibroids by their early 40s, and the same could be said for African American women in their mid-30s. After getting over the shock of how widespread fibroids are, the next question becomes, why the racial disparity? Is it diet, stress, environmental exposures? Maybe whatever it is could offer a clue as to what causes fibroids. For example, African Americans tend to have a lower intake of fruits and vegetables, and fruits and vegetables appear protective against fibroids, particularly citrus, here in the Black Women's Health Study, though not apparently just citrus juice. It's interesting, if you measure the levels of beta-carotene in fresh surgical tissue samples of uterine fibroids and adjacent normal uterus tissue obtained during hysterectomies, you find significantly lower concentrations in the fibroids. In fact, beta-carotene was not even detectable in half the fibroid specimens. The same thing is actually found in cancer. Most cancerous tissues tested had undetectable levels of beta-carotene compared to the normal tissue right next to the tumor. So maybe decreased levels of beta-carotene somehow plays a role in causing these conditions? Sounds like a bit of a stretch, but you don't know until you put it to the test. But there have never been a randomized controlled clinical trial of fruits and vegetables for fibroids until never. They did do a randomized controlled trial of a kind of a fruit and vegetable at the same time, tomatoes, but for the prevention of fibroids in Japanese quail. Most of my patients are not Japanese, nor quail. The action of lycopene, the red pigment in tomatoes in an animal model may not accurately represent lycopene action in humans. And indeed, the Harvard Nurses study found no apparent link between lycopene consumption and fibroids. So yeah, fruits and at least green vegetables may have a protective effect, but we won't know for sure until they're properly put to the test. Vitamin D is another possibility as to why African Americans disproportionately suffer from fibroids. Women with darker skin are more likely to be vitamin D deficient, as many as 80% of black women may have inadequate levels of vitamin D, compared to only one in five white women. Vitamin D does inhibit fibroid cell proliferation in a Petri dish. It may be able to shrink tumors in your pet rat, but what about people? The population study did find that women with sufficient vitamin D levels in their blood had about a third lower odds of fibroids, consistent with the finding that women who report lots of sun exposure also appear to be protected, but until there's an interventional trial where women are randomized to vitamin D or placebo, we won't know for sure if vitamin D plays a role in fibroid prevention or treatment or not. African American women are also more likely to sprinkle baby powder on their genitals, which may not only double the odds of fibroids, but may increase the risk of ovarian cancer, the deadliest gynecological cancer. Internal memos show Johnson and Johnson knew about the cancer risk, but still decided to target African Americans. Think of us, Johnson and Johnson said, as a lifetime friend of the family, a lifetime cut short, perhaps, by its baby powder. Or at least so said a jury, which recently awarded a family $110 million in damages on top of the $200 million in verdicts from last year, with thousands of lawsuits pending after internal memos revealed that decades ago, their own contracted toxicologists were warning the company that there are multiple studies showing a cancer link, and anyone who denies this risk will be perceived by the public in the same light as those who denied a link between smoking cigarettes and cancer, denying the obvious in the face of all evidence to the contrary.