By the time a person has symptoms of ovarian cancer, they are usually at an advanced stage. The treatment is extremely difficult and unfortunately most people will die. A in 78 women will develop ovarian cancer, and more than 230,000 women in the United States are currently affected. Of these, approximately 80% have no family history ovarian cancer and no indication that they were at risk of developing it.
In addition to the absence of early symptoms, late diagnosis occurs because there is no effective way to screen or diagnose ovarian cancer in its earliest forms. A recent study of hundreds of thousands of women showed that screening by ultrasound and blood test did not save as many lives as hoped. In fact, ineffective screening leading to false assurance (via a false negative result) is a serious concern even in high-risk patients.
Despite the name “ovarian cancer”, scientific discoveries over the past 20 years indicate that fallopian tubes (two thin tubes that allow eggs to travel from the ovaries to the uterus) as the site of origin for the most common and deadliest form of ovarian cancer, high-grade serous carcinoma. Researchers have found that the cells lining the fallopian tubes are particularly prone to mutations in a cancer-fighting gene called p53. These mutations allow the uncontrolled multiplication of cancer cells and their spread throughout the body. Studying p53 mutations in ovarian cancer, scientists have traced them to tiny precancers in the fallopian tubes.
With most ovarian cancers originating in the fallopian tube, researchers decided to investigate whether people whose fallopian tubes have been removed, which is done to suppress an ectopic pregnancy, treat the processes inflammation in the fallopian tube, and sometimes as a form of birth control, would have a reduced risk of developing ovarian cancer. Large epidemiological studies to show that it is, and it has opened the eyes of doctors like us. Given the seemingly insurmountable challenge of developing a screening test, clinicians are beginning to offer people who have terminated their pregnancies and are already undergoing planned surgeries the option of having their fallopian tubes removed to prevent prostate cancer. ovary. This strategy, called “opportunistic salpingectomy”, is safe and early evidence suggests it may reduce the risk of ovarian cancer by at least 65 percent. And as part of another gynecological surgery, the preventive removal of the fallopian tubes is supported by the American College of Obstetricians and Gynecologists and many professional societies around the world.
Removing a person’s fallopian tubes may seem like a drastic idea, especially because elective procedures carry risks, but in the United States alone, more than a million women undergo hysterectomies Or tubal ligations each year, which are often also considered elective. A simple change in surgical technique – removing the fallopian tubes along with the uterus during hysterectomy, and removing instead of “tying” the tubes for those opting for surgical contraception – would add ovarian cancer prevention to two of the most common gynecological procedures without the need for a separate medical intervention. It is a decision that we, as surgeons, believe is in the best interest of our patients.
For now, surgery is simply the best possible option to reduce the risk of ovarian cancer. Although ultrasound and other pelvic imaging techniques are helpful in visualizing the uterus and ovaries, they cannot reliably show us the fallopian tubes. Also, fallopian tube cancer cells likely spread while they are still microscopic. Technology that can both “see” the tube and identify microscopic precancers would be needed for effective screening.
It was equally difficult to find a biomarker for the early disease. Known biomarkers are usually only detectable in the bloodstream after the cancer has progressed well beyond the fallopian tubes and adjacent ovaries. Because early disease progression occurs through direct spread of microscopic cells from the fallopian tubes and onto the surfaces of organs and tissues of the abdominal cavity rather than through blood, blood biomarker testing may never be accurate. prove useful.
Unlike removal of the ovaries, which causes menopause, removal of the fallopian tubes has no known negative health consequences after pregnancy ends, and it adds minimal risk and time to performance and recovery from the initial surgery. Salpingectomy during hysterectomy and instead of tubal ligation for surgical contraception became standard practice in British Columbia more than 10 years ago. Researchers recently preliminary data published showing that this practice leads to a decrease in the incidence ovarian cancer in the general population. The possibility that we could reduce the number of people affected by this deadly cancer with a change in surgical practice that does not have lasting consequences after pregnancy ends is a game-changer. Extending this option to non-gynecologic surgery would exponentially increase the number of people with access to surgical prevention of ovarian cancer and is a cornerstone of ongoing implementation research.
It is important that people have more power over their health, especially when it comes to preventing cancer for which we have neither adequate screening nor a reliable cure. Work is underway to ensure that all patients seeking surgical contraception or undergoing hysterectomy are offered opportunistic salpingectomy. Also, efforts to extend this beyond gynecological procedures to operations such as gallbladder surgery, hernia repair and others are growing. Saving lives from ovarian cancer can become a reality in our lifetime if we provide the ability to remove fallopian tubes to the hundreds of thousands of patients undergoing abdominal surgery each year in the United States.
This is an opinion and analytical article, and the opinions expressed by the author or authors are not necessarily those of American scientist.