To prevent cancer, more women should consider having their fallopian tubes removed, experts say

There is no reliable screening test for ovarian cancer, so doctors advise women at high genetic risk of the disease to have their ovaries and fallopian tubes removed after they have finished having children, usually around age 40.

On Wednesday, a leading research and advocacy organization expanded that recommendation in ways that may surprise many women.

Building on the evidence that most of these cancers originate in the fallopian tubes, not the ovaries, the Ovarian Cancer Research Association encourages even women who don’t have the mutation—that is, most women—to have their fallopian tubes surgically removed if they’re done, you have children, and you’re planning a gynecological exam anyway. surgery.

In such a procedure, surgeons remove the tubes that lead from the ovaries to the uterus, but leave the ovaries intact. Ovaries produce hormones which are also useful later in life, reducing the risk of heart disease, osteoporosis and sexual dysfunction. Organ sparing is associated with overall lower mortality.

“Ovarian cancer is a relatively rare disease, and we typically don’t send messages to the general population,” said Audra Moran, president and CEO of OCRA. “We want everyone who has ovaries to know their level of risk and know what they can do to prevent ovarian cancer.”

For this purpose, the group also started offering free home test kits to qualified women who want to find out if they carry genetic mutations such as BRCA1 and BRCA2, which confer an increased risk of developing ovarian and breast cancer.

Younger mutation carriers might consider removing just their fallopian tubes as a temporary step to protect against ovarian cancer and avoid sudden early menopause, Ms. Moran said, although the gold standard treatment for carriers is to also remove the ovaries.

While women with BRCA1 and BRCA2 mutations have a very high risk of ovarian cancer, most women with the disease do not have the mutations.

The new advice is an acknowledgment that efforts to develop life-saving screening tests for early detection of ovarian cancer have failed and that women should consider more proactive measures.

This was shown by a large clinical trial in Britain imaging tests and blood tests for early detection of ovarian cancer they didn’t find the cancer early enough to save lives.

There were women told to pay attention to vague symptomslike flatulence, it could mean something is wrong, but experts say there is no evidence that vigilance prevents death because symptoms generally appear later in the course of the illness.

The Society of Gynecologic Oncologists, an organization of physicians who treat gynecologic cancers, has endorsed a new effort to make genetic testing more accessible and promote prophylactic tubal removal in women without genetic risks.

“It’s considered experimental,” said Dr. Stephanie Blank, the society’s president. But “it makes scientific sense and it’s very attractive.”

“Removing the fallopian tubes is not as good as removing the fallopian tubes and ovaries, but it’s better than screening that doesn’t work,” she said.

dr. Bill Dahut, chief scientific officer at the American Cancer Society, or ACS, said, “There’s a lot of good data behind what they’re suggesting, showing that for people who have had that surgery, the incidence rates of ovarian cancer are lower.”

“If you look at the biology, maybe we should call it fallopian tube cancer and think about it differently, because that’s where it starts,” he said.

According to the ACS, ovarian cancer is the fifth leading cause of cancer death in women and accounts for more deaths than any other cancer of the female reproductive system. Every year, some 19,710 women in the United States have been diagnosed with ovarian cancer and about 13,000 women die from it.

The disease is a particularly hidden malignancy, which is why it is often diagnosed at a very advanced stage. Ovarian cancer is far less common than breast cancer, which affects 264,000 women and 2,400 men in the US each year, but 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 age 35 to 40 for women with the BRCA1 mutation and at age 40 to 45 for women with the BRCA2 mutation, Dr. Blank said. Ideally, women will have given birth by then.

But women who do not have a clear family history of ovarian or breast cancer may not be aware that they carry the mutations.

Monica Monfre Scantlebury, 45, of St. Paula, Minn., discovered she had the BRCA1 mutation in 2017, when her younger sister was diagnosed with metastatic breast cancer when she was 27.

Their mother did not have the mutation, meaning they inherited it from their deceased father. His mother, Mrs Scantlebury’s grandmother, died in her 40s from breast and ovarian cancer.

While the family talked about heart disease, cancers in women were only whispered about, she recalled in an interview. After her sister died in 2020, Ms Scantlebury had her fallopian tubes removed, along with an ovary that appeared to have a growth.

“I was in my early 40s and my doctors at that point were less concerned about me getting breast cancer and more concerned about the high risk of ovarian cancer,” she said.

A few days later, she received a call from a doctor who said that cells believed to be precursors to high-grade serous ovarian cancer had been found in one of her removed fallopian tubes. Mrs Scantlebury decided to remove her uterus and cervix, along with the remaining right ovary.

Those decisions were not easy. “I chose not to have any biological children, which was difficult,” she said. “And I’m still at risk of breast cancer.” But she added, “I was named after my grandmother and I believe the surgery prevented me from having the same obituary as her.”

The practice of removing the fallopian tubes while the patient is already having another pelvic surgery, called an opportunistic salpingectomy, is already standard care in British Columbia, said Dr. Dianne Miller, who until recently was director of gynecologic cancer services there.

“Fifteen years ago, it became apparent that the most deadly and common types of high-grade cancers actually originate in the fallopian tubes, not the ovaries, and then spread very quickly,” Dr. Miller said.

By the time women experience symptoms like bloating or abdominal pain, she said, it’s too late to do anything life-saving.

“I remember the moment when the light bulb went off that many of these cancers are probably preventable, because many women at some point have a hysterectomy, or a fibroid, or a tubal ligation,” Dr. Miller said.

It used to be routine to remove the ovaries during a hysterectomy, as this reduced the risk of breast cancer and nearly eliminated ovarian cancer. For high-risk women, it is still the preferred option.

But for women at average risk of ovarian cancer, Dr. Miller said, removing only the fallopian tubes is a “win-win” situation, reducing the risk of ovarian cancer even as intact ovaries continue to produce small amounts of hormones that help keep the brain and heart healthy. later in life.

“As oncologists, our eyes are on the cure of cancer,” said Dr. Miller. “But if there’s one thing that’s absolutely better than curing cancer, it’s not getting it at all.”