Topic: Reducing ovarian cancer risk without removing the ovaries

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What is this about?

The Ovarian Cancer Research Alliance (OCRA) now recommends that all women who need pelvic surgery and have finished having children consider having their fallopian tubes removed at the same time.

Why is this important?

No test or screening can detect for ovarian cancer at an early stage. For this reason, ovarian cancer is often not found until the later stages when it is harder to treat. One way to decrease your risk of ovarian cancer may be to have your fallopian tubes removed while you are having pelvic surgery.

Most ovarian cancer starts in the fallopian tubes, NOT in the ovaries

About 15-20 years ago, experts thought that most ovarian cancers started on the surface of the ovaries. However, more recent research has shown that most ovarian cancer begins in the fallopian tubes. This discovery inspired researchers to study whether removing the fallopian tubes (a surgery called salpingectomy) after women are done having children lowers their risk for ovarian cancer.

Removing the fallopian tubes during pelvic surgery

Many experts agree that for women of average ovarian cancer risk, removing the fallopian tubes during another surgery in the pelvis (the area between the stomach and legs) is an effective preventive measure. Screening for ovarian cancer is not effective. Removing the fallopian tubes to reduce ovarian cancer risk is already standard of care in Canada and other countries for women of average risk.

The new advice from OCRA recognizes that efforts to develop lifesaving screening tests for early detection of ovarian cancer have been unsuccessful and that women should consider more proactive measures.

Dr. Dianne Miller, a former leader of gynecologic cancer services in British Columbia, was quoted in the New Your Times:

“I remember the light-bulb-going-off moment that many of these cancers [ovarian] are likely preventable, because a lot of women have a surgery at some point for hysterectomy, or removal of fibroids, or tubal ligation.”

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

What about high-risk women?

Removing the ovaries and the fallopian tubes is the most proven way to lower the risk of ovarian cancer in high-risk women. However, ovary removal has been linked to several risks, including increased heart disease, bone weakening, sexual side effects and other issues.

It is important to know that removing the fallopian tubes while sparing the ovaries to lower ovarian cancer risk in high-risk women is still considered experimental. For high-risk patients who choose to have their fallopian tubes removed first, removing their ovaries during the time period recommended by national guidelines is recommended. At the time of this review, research studies are ongoing to assess the safety of removing the fallopian tubes first with delayed ovary removal. These studies are being done to see if this approach lowers the risk for ovarian cancer while minimizing the effects of menopause in high-risk women.

 A study in the Netherlands found that people with a BRCA mutation have better quality of life after removal of only the fallopian tubes with removal of ovaries later compared to removal of both ovaries and fallopian tubes at the same time. You can read more about this study in our XRAY review here.

What does this mean for me?

High-risk women

If you are at high risk for ovarian cancer due to an inherited mutation, removing the ovaries along with the fallopian tubes has been shown to significantly lower your risk for developing and dying from ovarian cancer. Current expert guidelines recommend removal of the ovaries and fallopian tubes once you no longer plan to become pregnant, to lower your risk for cancer.

Ovary removal, even after menopause, has been linked to increased risk of heart disease, bone weakening, sexual side effects and other issues. If you are concerned about the side effects of surgical menopause or you are not ready to remove your ovaries, ask your surgeon if participating in a clinical trial studying removal of the fallopian tubes with delayed removal of the ovaries might be right for you.

Average risk women

If you are a woman at average risk for ovarian cancer and are not planning on becoming pregnant in the future and need to have any type of pelvic surgery, you should ask your surgeon about the benefits and risks of removing your fallopian tubes at the time of your surgery.

Reference

Rabin RC. “To Prevent Cancer, More Women Should Consider Removing Fallopian Tubes, Experts Say.” The New York Times. Feb. 1, 2023.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

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posted 7/18/23