A pioneering surgical technique developed in British Columbia is showing remarkable promise in the fight against ovarian cancer, a disease that claims the lives of approximately 2,000 Canadian women annually. New research indicates that proactively removing the fallopian tubes during common gynecological surgeries-a procedure known as opportunistic salpingectomy-can reduce a woman’s risk of developing ovarian cancer by 78%. This preventative measure addresses a critical gap in women’s healthcare, as there are currently no reliable screening methods for this often-deadly cancer.
A preventative surgical procedure pioneered in British Columbia appears to significantly reduce a woman’s risk of developing the most common and deadly form of ovarian cancer – a devastating disease where half of those diagnosed survive no more than five years.
The opportunistic salpingectomy involves proactively removing the fallopian tubes during a routine gynecological surgery, such as a hysterectomy or tubal ligation.
Women who underwent this procedure were 78% less likely to develop ovarian cancer, according to a recent research letter published in the medical journal JAMA Network Open. And, in the rare cases where the disease did develop, it was biologically less aggressive.
“There’s no good cancer, but ovarian cancer is a particularly nasty disease,” said Dr. Lucy Gilbert, director of the division of gynecologic oncology and the Women’s Health Research Unit at McGill University Health Centre.
“You can do prevention, at best you can offer surgery and ablation, but when you’re faced with advanced disease, it becomes very difficult.”
Origin
For years, experts logically searched for the origin of ovarian cancer directly within the ovaries, explained Dr. Gilbert.
However, it was realized several years ago that “the vast majority of ovarian cancers, serous ovarian cancers, actually arise from the fallopian tubes,” rather than the ovaries, she added.
“The poor ovary is innocent. I made that mistake too, and we were foolish. We wasted a lot of time trying to detect ovarian cancer with imaging,” Dr. Gilbert said.
Examining the ovaries and even fallopian tubes of a woman presenting with early symptoms of ovarian cancer often reveals nothing abnormal, she added, “but we believe that a small cancer is already hidden in the abdomen. We were simply looking in the wrong place.”
“We were focusing on something innocent, while the culprit had already begun spreading cancer cells throughout the body even though it appeared perfectly healthy,” Dr. Gilbert explained.
Procedure
The opportunistic salpingectomy was developed by a team of researchers from the University of British Columbia, BC Cancer, and Vancouver Coastal Health. In 2010, British Columbia became the first jurisdiction in the world to offer the procedure, which is now recommended by medical organizations in 24 countries.
The procedure preserves the integrity of the ovaries, maintaining important hormone production and minimizing side effects associated with additional surgery. This is particularly important, as ovarian cancer is a leading cause of cancer death among women, and early detection remains a significant challenge.
The new study is the first to quantify the reduction in ovarian cancer risk associated with the procedure. The findings are based on an analysis of health data from a population of over 85,000 people who underwent gynecological surgery in British Columbia between 2008 and 2020. Researchers compared ovarian cancer rates between those who underwent opportunistic salpingectomy and those who had similar surgeries without the procedure.
“We can really be proud that the basis of this study is Canadian,” Dr. Gilbert commented. “It’s a great idea. Since we can’t screen for these cancers early with the tools we have, why not take advantage of another surgery to remove the fallopian tubes?”
The goal, she said, isn’t to start “harassing all women to have their fallopian tubes removed.” But since surgery is already a serious intervention, “if you’re already going into someone’s abdomen to tie their tubes, why not just remove them?” she asked.
“You might as well take the opportunity to do something that will reduce the risk of the eighth or ninth most common cancer in women,” Dr. Gilbert emphasized.
A Serious Decision
A woman must be certain she does not want children in the future, but this is less of a concern if the patient is already undergoing a hysterectomy or tubal ligation, she stressed.
The downside is that it’s a longer and more complex procedure, and there’s some concern about interfering with blood supply to the ovaries, potentially leading to slightly earlier menopause, “but in life, you have to weigh the pros and cons, and ultimately, I think it’s a brilliant idea, the benefits are so much greater,” Dr. Gilbert applauded.
Ovarian cancer is the most lethal gynecological cancer. Approximately 3,100 Canadian women are diagnosed with the disease each year, and around 2,000 die from it.
Currently, there are no reliable screening tests for ovarian cancer, meaning most cases are diagnosed at an advanced stage when treatment options are limited and survival rates are low. This underscores the importance of preventative measures like opportunistic salpingectomy.
