A top research group is urging more women, even those without genetic risks, to have their fallopian tubes removed under certain circumstances, acknowledging that general screening and testing does not detect ovarian cancer, which usually starts in the fallopian tubes, early enough.
The doctors say there is no reliable screening test for ovarian cancer, so those at high genetic risk for the disease should have their ovaries and fallopian tubes removed once they have had their children, usually around the age of 40s.
Building on evidence that most of these cancers originate in the fallopian tubes, not the ovaries, the Ovarian Cancer Research Alliance (OCRA) is urging women who do not have mutations – that is, most women – to have their fallopian tubes surgically removed after they stop having children and if they are “planning a gynaecological operation anyway”.
In such a procedure, reports The New York Times, surgeons remove the tubes, which lead from the ovaries to the uterus, but leave the ovaries intact. The ovaries produce hormones that are beneficial even later in life, reducing the risk of heart disease, osteoporosis and sexual dysfunction. Sparing the organs has been linked to lower mortality overall.
“Ovarian cancer is a relatively rare disease, and typically, we don’t message to the general population,” said Audra Moran, president and chief executive of OCRA. “We want everyone with ovaries to know their risk level and the actions they can take to help prevent ovarian cancer.”
The group has also begun offering free at-home testing kits to qualifying women who want to find out if they carry genetic mutations such as BRCA1 and BRCA2, which confer an elevated risk for developing both ovarian and breast cancer.
Younger carriers of the mutations might consider removing only the fallopian tubes as an interim step to protect against ovarian cancer, and to avoid abrupt early menopause, Moran said, even though the gold-standard treatment for carriers is to remove the ovaries, too.
While women with BRCA1 and BRCA2 mutations have a heightened risk for ovarian cancer, most women with the disease do not carry mutations.
The new advice is an acknowledgment that efforts to develop lifesaving screening tests for early detection of ovarian cancer have failed, and that women should consider more proactive measures.
A large clinical trial in Britain found that imaging scans and blood tests for early detection of ovarian cancer did not find the cancer early enough to save lives.
Women have been told to heed vague symptoms, like bloating, that could indicate something amiss, but experts say there is no evidence this prevents deaths because symptoms generally occur later in the course of the illness.
The Society of Gynaecologic Oncology, an organisation that treats gynaecological cancers, has endorsed the new push to make genetic testing more accessible and to promote prophylactic removal of the fallopian tubes in women without genetic risks.
“It is considered experimental,” Dr Stephanie Blank, president of the society, told The New York Times. “But it makes scientific sense and has a lot of appeal.
“Removing the tubes is not as good as removing the tubes and the ovaries, but it’s better than screening, which doesn’t work,” she said.
Dr Bill Dahut, chief scientific officer at the American Cancer Society (ACS), said: “There is good data behind what they’re suggesting, showing that for folks who had that surgery, the incidence rates of ovarian cancer are less.”
“If you look at the biology, maybe we should be calling it fallopian tube cancer and think of it differently, because that’s where it starts,” he said.
Ovarian cancer ranks fifth in cancer deaths among women, according to the ACS, accounting for more deaths than any other cancer of the female reproductive system.
The disease is a particularly stealthy malignancy, often diagnosed at a very advanced stage as a result. It is far less common than breast cancer, which is diagnosed in 264 000 women and 2 400 men each year in the US, but its survival rates are much lower.
In women with BRCA1 and BRCA2 genetic mutations, surgeons generally remove the ovaries as well as the fallopian tubes – at ages 35 to 40 in women with the BRCA1 mutation and ages 40 to 45 in those with the BRCA2 mutation, Blank said. Ideally, the women will have completed childbearing by then.
Removing the fallopian tubes while a patient is already having another pelvic surgery, called opportunistic salpingectomy, is already standard care in British Columbia, said Dr Dianne Miller, who, until recently, was the leader of gynaecological cancer services there.
“Fifteen years ago, it became apparent that the most lethal and most common kinds of high-grade cancers actually had their origin in the fallopian tube rather than the ovary, and then spread very quickly,” she said.
By the time women experience symptoms like bloating or abdominal pain, she added, it is too late to do anything to save lives.
“I remember the light-bulb moment that many of these cancers are probably preventable, because many women have a surgery at some point for hysterectomy, or removal of fibroids, or tubal ligation.”
It was once routine to remove the ovaries during a hysterectomy, because it reduced the risk of breast cancer and all but eliminated ovarian cancer. For women at high risk, that is still the preferred option.
But for women at average risk for ovarian cancer, Miller said, removing only the fallopian tubes is a “win-win” situation, reducing ovarian cancer risk even as the intact ovaries continue producing small amounts of hormones that help keep the brain and heart healthy later in life.
“As oncologists, we have our eyes set on curing cancer,” she said. “But if there’s one thing that’s absolutely better than curing cancer, it’s not getting it in the first place.”
See more from MedicalBrief archives:
Annual screening for ovarian cancer does not save lives — Large UK trial
Why some breast and ovarian cancers are resistant to chemotherapy – US study
Most UK women mistakenly believe pap smear will detect ovarian cancer
Blood test has potential to detect ovarian cancer
Biomarker may predict response to ovarian cancer therapy