The discovery that most ovarian cancers start, not in the ovaries, but the Fallopian tubes, means there may be a way to help prevent a disease that kills about 1000 women in Australia each year.
It works like this: if you’re a woman having planned abdominal surgery such as a hernia repair, gallbladder surgery, hysterectomy, or planned caesarean, you should be able to ask to have your Fallopian tubes removed at the same time. The procedure, called an opportunistic salpingectomy, has been adopted in Canada, and is recommended by some Australian doctors to women who have finished having children.
A new study by Canada’s University of British Columbia published this month found that women who had this procedure were 78 per cent less likely to develop the most common and lethal type of ovarian cancer, compared with those who had not had their Fallopian tubes removed.
One gynaecologist recommending this surgery in Australia is Associate Professor Orla McNally, director of gynaecological oncology at the Royal Women’s Hospital in Melbourne.
“We’ve known for about 20 years that the majority of the most lethal ovarian cancers start in the Fallopian tubes. If this procedure were done routinely, it could reduce the numbers of ovarian cancers by 65 per cent – and this could save a lot of lives,” she says.
“Ovarian cancer is a complex disease, and there’s no screening test that can find it in the pre-cancerous or early stages, as you can with cervical cancer, for example. By the time it’s detected it’s usually well advanced, and most women die within five years.”
Last year, Melbourne-based physiotherapist Alex Armstrong had her Fallopian tubes removed during keyhole surgery to treat adenomyosis, a condition similar to endometriosis that causes heavy, painful periods.
Her motivation was a strong family history of cancer.
“I’d lived in the shadow of this disease all my life because my mother, grandmother and great aunt all had breast cancer, and my great-grandmother died of ovarian cancer. I was 16 when my grandmother died of breast cancer, then my mother was diagnosed with it when I was 20,” says Armstrong, now 39.
“My mother’s prognosis was good, but the memories of what my grandmother went through came flooding back, and I felt overwhelmed.”
Genetic testing eventually brought good news and bad news. Her mother, Shari, carried the BRCA2 gene mutation that increases the risk of both breast and ovarian cancer, but Armstrong herself didn’t.
But Shari’s experience with cancer didn’t stop there. When she opted for surgery to remove her ovaries to reduce her chances of more cancer, the surgeon found a tumour in her Fallopian tubes. She also went on to develop peritoneal cancer, which attacks the lining of the abdominal wall and is more common in women carrying the BRCA2 mutation.
“She’s responded well to treatment and is in remission, but because of the experience of cancer in my family I felt intuitively that having my Fallopian tubes removed was the right thing to do, even though I don’t have the same mutation,” says Armstrong.
“I’d heard about the surgery from a friend whose doctor had suggested it to her. My own doctor agreed to do it while he was treating the adenomyosis. He said it would take an extra 10 to 15 minutes.”
She says the birth control that came with removing the tubes was another bonus.
An important distinction when considering this surgery, according to experts, is the difference between removing the ovaries and Fallopian tubes.
“Unlike removing the ovaries, removing the Fallopian tubes doesn’t bring on early menopause and doesn’t appear to affect production of hormones,” says McNally. “It’s true that any surgery carries a risk, but if you’re already having surgery, any extra risk from having the Fallopian tubes removed is minimal.”
But how easy is it for women to opt to have their tubes removed alongside other planned surgery?
It’s a work in progress, says Martha Hickey, professor of obstetrics and gynaecology at the University of Melbourne.
She leads the Australian part of an international study to test if women at high risk of ovarian cancer due to BRCA1/2 gene mutations can safely have only their tubes removed, rather than both tubes and ovaries, to reduce their ovarian cancer risk. Having ovaries as well as tubes removed is very effective but will lead to surgical menopause, she says.
“[This surgery] is very new and although it’s straightforward for a gynaecologist to remove the tubes at the time of procedures like hysterectomy, surgeons specialising in gastric surgery or hernia repair may need more training or have a gynaecologist alongside them,” she says.
To increase their options, she suggests women speak to their surgeon directly ahead of other planned abdominal operations.
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