In promising news on the prevention front, one surgical procedure that leaves the ovaries intact may greatly reduce the risk of ovarian cancer. Recent research findings show that the surgical removal of fallopian tubes in a procedure known as an opportunistic salpingectomy may prevent the most common subtype of ovarian cancer from developing. The procedure can be performed as part of other routine gynecologic surgeries even when there is no known family history of the disease, meaning countless individuals could be prevented from ever getting ovarian cancer.
An opportunistic salpingectomy (OS) specifically involves the removal of fallopian tubes during a hysterectomy or in place of tubal ligation while leaving the ovaries intact. The procedure was developed as an ovarian cancer prevention strategy by Dr. Dianne Miller of Vancouver Coastal Health’s Vancouver General Hospital and BC Cancer in British Columbia, Canada.
“Though it’s great to cure cancer or improve outcomes, it’s even better to never get cancer in the first place and that’s what this ovarian cancer prevention strategy is all about,” said Dr. Miller.
Implementing OS as a prevention strategy came about after scientists discovered that the most common subtype of ovarian cancer — high-grade serous cancer (HGSC) or high-grade serous ovarian cancer (HGSOC) — begins in the fallopian tubes. It was previously widely believed that ovarian cancers originate in the ovaries. Importantly, OS can be performed at the same time as other routine gynecologic surgeries even if a patient is not considered at high risk for ovarian cancer.
“Opportunistic salpingectomy is not targeted toward specific patients. It is not meant for high-risk patients,” said OCRA’s Scientific Advisory Committee member Dr. Celeste Leigh Pearce at University of Michigan, who co-authored the recent study. “We are targeting the 80% of high-grade serous cancers that arise in people with no genetically increased risk for ovarian cancer and trying to reduce the incidence of ovarian cancer overall by providing this safe and seemingly effective procedure at the time of hysterectomy or instead of tubal ligation.”
With various professional gynecologic societies around the world currently recommending OS as a risk-reducing surgery, Dr. Pearce and a team of researchers at The University of British Columbia conducted a population-based, retrospective cohort study to evaluate if the procedure is associated with fewer than expected ovarian cancers.
The researchers evaluated data on 25,889 individuals residing in British Columbia who underwent OS between 2008 and 2017. They compared this information with findings from a control group consisting of 32,080 British Columbia residents who had undergone a hysterectomy alone or tubal ligation during this same time period.
“The study found significantly smaller numbers of observed ovarian cancers compared with expected numbers for patients who underwent prophylactic OS at the time of hysterectomy or instead of tubal ligation,” said senior author Dr. Gillian E. Hanley of The University of British Columbia and the Vancouver Coastal Health Research Institute. “There was not a single serous ovarian cancer in the OS group, which was significantly fewer than the slightly more than five that were expected.”
In contrast, the researchers observed 15 serous cancers in the control group and expect that the number will grow to 45.1 cases by 2027 based on their calculations.
“We now have what appears to be an effective way to prevent women from ever getting ovarian cancer, and we hope that these findings will encourage more physicians and patients to consider removal of fallopian tubes during pelvic surgeries where the tubes are accessible,” said Dr. Hanley. “If our results are correct, the more tubes we remove, the more we will decrease the incidence of this terrible disease.”
Read more at JAMA Network Open.