This simple surgery could lower ovarian cancer rates in Canada, specialists say

Lindsay Mazepa had never heard of opportunistic salpingectomy.

But when Mazepa discussed her upcoming cesarean section for the birth of her twins, her obstetrician-gynecologist suggested the procedure instead of the family planning tubal ligation they were already considering.

The 43-year-old mother of three in Port Coquitlam, BC, says her doctor explained at the time that the procedure would “significantly reduce” the chances of developing ovarian cancer in the future.

Opportunistic salpingectomy is the removal of the fallopian tubes in an intermediate-risk woman who has finished having children and is already undergoing gynecologic surgery, such as a caesarean section or surgery for endometriosis. The ovaries are left intact.

In a tubal ligation performed solely as a method of permanent contraception, the fallopian tubes are usually cut, clamped, or sealed, but not removed.

“Considering I was already having surgery and she had said there would literally only be an extra 10 minutes of procedure, the recovery period would be exactly the same, that was really all I needed to be told it would reduce my risk of [ovarian] cancer in the future,” said Mazepa, a neurodiagnostic technologist White coat, black art.

The procedure is considered one of the few ways to reduce the risk of ovarian cancer, which doctors say is difficult to detect. There is no effective screening test for the disease.

About one in 75 Canadian women will be diagnosed with ovarian cancer, according to Ovarian Cancer Canada.

Early research has shown that an opportunistic salpingectomy may help reduce the risk of ovarian cancer.

“We now recognize that the majority of ovarian cancers are a specific subtype called high-grade serous carcinoma and that most of these cancers actually originate in the fallopian tube, not the ovary,” said Dr. Janice Kwon, a gynecologic oncologist at Vancouver General Hospital and BC Cancer, and vice chief of the Department of Obstetrics and Gynecology at the University of British Columbia.

Opportunistic salpingectomy has been done in Canada for over a decade in women who have finished having children and are already undergoing gynecological surgery.

BC has led the country in the number of opportunistic salpingectomies performed.

Preliminary data analyzed by associate professor Gillian Hanley and colleagues at the University of British Columbia of obstetrics and gynecology show that acceptance has grown since their last look at data from all provinces except Quebec from 2011 to 2016.

“It looks like rates are going up in other counties, which is great,” Hanley said White coat, black art. “But there is certainly room for improvement.”

Previously, rates were very low, less than one in ten, in several maritime provinces. Now in Nova Scotia, Hanley said nearly half of tubal sterilizations are opportunistic salpingectomy.

Hanley said she would like to see greater adoption in PEI, Newfoundland and Labrador, Ontario and Manitoba, saying opportunities to save lives are being missed.

A Canadian discovery

Dr. Dianne Miller, associate professor emerita in UBC’s department of obstetrics and gynecology, was the first develop and name opportunistic salpingectomy as a prevention strategy for ovarian cancer.

In 2010, an education campaign was launched in BC to explain the benefits of opportunistic salpingectomy.

Kwon says that before 2010, “a very small proportion of women” had their fallopian tubes removed, sometimes to prevent an unplanned pregnancy or during a hysterectomy for noncancerous reasons, such as abnormal bleeding or endometriosis.

Since then, several organizations in Canada and elsewhere have made recommendations for people at intermediate risk of ovarian cancer to consider an opportunistic salpingectomy.

Most recently in February, the worldwide non-profit Ovarian Cancer Research Alliance and the Society of Gynecologic Oncology in the US released a joint statement encouraging women undergoing pelvic surgery to also have their fallopian tubes removed.

Hanley said BC’s opportunistic salpingectomy approach is recommended in nine other countries. Researchers inside The Netherlands found when healthcare professionals offered the procedure to patients, nearly 96 percent chose to proceed.

LOOK | Why specialists recommend doctors to talk to patients about the operation:

The procedure takes less than 15 minutes and is “very, very safe,” said Dr. Raz Moola, an obstetrician-gynecologist at Kootenay Lake Hospital. He routinely performs the surgery, but said he stands by his patients about what it can and cannot do.

“It’s important from my perspective to make it clear to patients that this procedure is ideally meant to prevent something from happening, but we don’t actually know that will happen,” he said, adding that fallopian tube cancer is one of about 20 are different types. of ovarian cancer.

The potential to lower risk

Donna Pepin was diagnosed with ovarian cancer in 2006, which returned ten years later.

Pepin remembers being at the event in 2010 gynecologists in BC encouraged mid-risk women to undergo opportunistic salpingectomy.

“I remember feeling so emotional at the time because I thought you know the lives that could potentially be saved, the suffering that could be avoided. For me, this was a really huge moment of understanding, especially as I’m sharing my own journey with ovarian cancer. cancer.”

Pepin has participated in clinical trials, undergone several chemotherapy regimens, and surgery.

She was healthy for nine years. But in 2016, she was diagnosed with low-grade serous ovarian cancer, a rare type.

The 65-year-old is taking medication that has stabilized her disease.

The Ovarian Cancer Canada volunteer says it has been exciting to see the medical science community making progress in ovarian cancer prevention.

“As an ovarian cancer patient, the whole community would agree that this is great if only to be able to prevent it because there is no Pap test. There is no way to detect our disease. There is no way to prevent we know in addition to this, opportunistic salpingectomy.”

In addition, other health problems can cause the same symptoms as ovarian cancer, according to the Canadian Cancer Society website.

Kwon also says the majority of women get ovarian cancer at an advanced stage where the cancer has spread (also known as metastasized) to other parts of the body.

“This becomes difficult to treat and cure,” she said.

Since the opportunistic salpingectomy education campaign only started a little over 10 years ago, it’s still early to say what the real benefits of this procedure are, says Kwon.

But she adds that early research is “exciting news.”

Research by Hanley, Kwon and colleagues published in the peer reviewed The Journal of the American Medical Association found last year that opportunistic salpingectomy could help reduce the number of ovarian cancers.

Ovarian cancer is something I see almost every day… and any chance we have to prevent ovarian cancer is definitely worth it.– Janice Kwon

They found that the nearly 26,000 individuals who underwent opportunistic salpingectomy had significantly less serous and epithelial ovarian cancer than expected, compared to the percentage among the control group who underwent either hysterectomy or tubal ligation alone.

In particular, when they looked at high-grade serous cancers, not a single case was found in those who had their fallopian tubes removed.

“Ovarian cancer is something I see almost every day. I’ve treated hundreds of women with that disease and any chance we have to prevent ovarian cancer is definitely worth it,” Kwon said.