Topic: Reducing ovarian cancer risk without removing the ovaries
A leading ovarian cancer organization has recommended that all women who have pelvic surgery should also consider removing their fallopian tubes to reduce their risk of ovarian cancer. (Posted 7/18/23)
RELEVANCE
Most relevant for: People who are not at high risk of ovarian cancer who are having pelvic surgery.
It may also be relevant for:
- healthy people with average cancer risk
- people with a genetic mutation linked to cancer risk
- people with a family history of cancer
Relevance: Medium-High
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 removed at the same time.
Why is this important?
No test or screening can detect for ovarian cancer at an early . 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 ) 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 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.
