This simple surgery could reduce ovarian cancer rates in Canada, experts say

Lindsay Mazepa had never heard of opportunistic salpingectomy.

But when Mazepa was talking about her upcoming C-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, British Columbia, said her doctor explained at the time that the procedure would “significantly reduce” the risk of ovarian cancer in the future.

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

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

“Given I was already in surgery and she mentioned there would literally only be an additional 10 minute procedure, the recovery period would be exactly the same, that was really all I needed. needed to hear that 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 can be 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 studies have shown that an opportunistic salpingectomy can 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 the majority of these cancers actually arise in the fallopian tube, not the ovary,” said said Dr. Janice Kwon, gynecological 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 more than a decade on women who no longer have children and who are already undergoing gynecological surgery.

British Columbia leads the country in the number of opportunistic salpingectomies performed.

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

“It looks like the rates are going up in other provinces, which is great,” Hanley said. White Coat, Black Art. “But there is always room for improvement.”

Previously, rates were very low, less than one in 10, in several Maritime provinces. Now in Nova Scotia, Hanley said nearly half of tubal sterilizations are opportunistic salpingectomies.

Hanley said she would like to see greater participation in Prince Edward Island, Newfoundland and Labrador, Ontario and Manitoba, saying life-saving opportunities are being missed.

A Canadian discovery

Dr. Dianne Miller, Associate Professor Emeritus 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 British Columbia to explain the benefits of opportunistic salpingectomy.

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

Since then, several organizations in Canada and elsewhere have issued recommendations for people at average risk of ovarian cancer to consider having opportunistic salpingectomy.

Most recently, in February, the global nonprofit Ovarian Cancer Research Alliance and the Society of Gynecologic Oncology in the United States issued a joint statement encourage women undergoing pelvic surgeries to also have their fallopian tubes removed.

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

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The procedure takes less than 15 minutes and is “very, very safe,” said Dr. Raz Moola, an obstetrician-gynecologist based at Kootenay Lake Hospital. He regularly performs the operation, but says he is upfront with his patients about what he can and cannot do.

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

The potential to reduce risk

Donna Pepin was diagnosed with ovarian cancer in 2006, which recurred a decade later.

Pepin remembers being at the 2010 event when gynecologists in British Columbia encouraged women at average risk to undergo opportunistic salpingectomy.

“I remember at the time, I felt so moved because I thought you knew the lives that could be saved, the suffering that can be avoided. For me, it was this really huge moment of understanding, especially after going through my own journey with ovarian cancer.”

Pepin participated in clinical trials, completed several cycles of chemotherapy treatment and underwent surgery.

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

The 65-year-old is taking medication which has kept her illness stable.

The Ovarian Cancer Canada volunteer says it’s exciting to see the medical science community making progress in preventing ovarian cancer.

“As a patient with ovarian cancer, our whole community would agree that it’s amazing to be able to prevent it from happening because there’s no Pap test. There’s no way to detect our disease. There’s no way to prevent it that we know of other than this, opportunistic salpingectomy.”

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

Additionally, Kwon says the majority of women are diagnosed with ovarian cancer at an advanced stage where the cancer has spread (also known as metastasis) to other parts of the body.

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

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

But she adds that the 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 cancer cases.

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

They found that nearly 26,000 people who underwent opportunistic salpingectomy had significantly fewer serous and epithelial ovarian cancers than expected, compared to the rate in the control group who underwent only hysterectomy or tubal ligation. .

When they looked at high-grade serous cancers in particular, no cases were found among those whose fallopian tubes had been removed.

“Ovarian cancer is something I see almost daily. I have treated hundreds of women with this disease and all the opportunities we have to prevent ovarian cancer are certainly worth it,” Kwon said.