Preventing Ovarian Cancer

By Dr. Dianne Miller FRCSC, OVCARE Clinical Director and Provincial Gynaecologic Tumour Group Chair for BC; Dr. Sarah Finlayson FRCSC, Gynecologic Oncology, VGH & BCCA

Our understanding of Ovarian Cancer is evolving. New knowledge is exciting, and powerful. Over the last 20 years, we have approached most cases of Ovarian Cancer with the same treatment recipe. Unfortunately, during this time, survival from Ovarian Cancer has not improved significantly. But we believe there is a light at the end of the tunnel.

We are now confident that “Ovarian Cancer” is not a single disease. This knowledge allows researchers and clinicians to tackle Ovarian Cancer one subtype at a time. Focusing our research in this way holds promise for a quicker pace of discovery. We are already changing our “one size fits all” approach to Ovarian Cancer based on new discoveries.

But until such time as we have improved treatments and early screening techniques, preventing this cancer remains the cornerstone of hope. Researchers have recently discovered that the most common type of Ovarian Cancer (high-grade serous carcinoma), does not begin in the ovary at all. Most of these cancers actually begin in the lining of the fallopian tube. This knowledge is thrilling because it offers the very real possibility of preventing future cases of this devastating cancer.

Hysterectomy is one of the most common surgeries performed on Canadian women.  Hysterectomy is often used in the treatment of fibroids, endometriosis, and other benign gynecologic conditions. The function of the fallopian tube is to transfer eggs from the ovary into the uterus. When the uterus is removed at hysterectomy, the fallopian tube is no longer required.

In the recent past, when a woman had a hysterectomy and planned to leave her ovaries in place, the fallopian tubes were also left inside. This was our surgical convention; the role of the fallopian tube is obsolete once the uterus is removed. Knowing that the most common type of ovarian cancer begins in the fallopian tube means surgeons should consider changing surgical practice.

In September 2010, OVCARE launched an educational initiative aimed at all gynecologists in BC. An educational DVD was distributed to each gynecologist. We asked all gynecologists to immediately consider changing their surgical practice and to remove the fallopian tube at every hysterectomy. We also asked that they consider removing the fallopian tube at the time of tubal ligation, when a woman is requesting permanent contraception.

Read articles about this initiative:

The Society of Gynecologic Oncology of Canada (GOC) supports OVCARE’s cancer prevention strategy.
In September 2011, the GOC endorsed OVCARE’s cancer prevention strategy by issuing a statement recommending that “physicians discuss the risks and benefits of bilateral salpingectomy with patients undergoing hysterectomy or requesting permanent, irreversible contraception,” and that an “ovarian cancer prevention (research) study focused on fallopian tube removal is a GOC priority.”