Remove Tubes, Save Women From Ovarian CA

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Ovarian cancer often shows symptoms too late. By then, it's tough to treat and often fatal. Sadly, most people die from it. 1 in 78 women get ovarian cancer. In the U.S., over 230,000 women have it now. Shockingly, around 80% of them don't have a family history of the disease. Also, they had no sign they might get it.

Ovarian cancer is difficult to diagnose early. Symptoms are not evident at the start. Screening is also not useful. A recent study shows that ultrasounds and blood tests do not detect ovarian cancer well. False negative results are common and this is risky. Even high-risk patients are not successfully diagnosed.

Although it's called "ovarian cancer," research from the past 20 years shows that the fallopian tubes are where the deadliest and most common type, high-grade serous carcinoma, originates. Cells in the fallopian tubes are susceptible to mutations in the p53 gene that suppresses cancer, leading to uncontrollable cancer cell growth and spreading. Experts have linked these mutations to microscopic precancers in the fallopian tubes while researching ovarian cancer.

Doctors did research to see if removing the fallopian tubes would reduce the risk of ovarian cancer. They found that it does. This is good news because there is no good way to test for ovarian cancer. Some doctors are now offering to remove fallopian tubes to prevent ovarian cancer. This is safe and might reduce the risk of ovarian cancer by 65%. Many professional organizations support this strategy.

Many women have elective procedures like hysterectomies or tubal ligations every year in the U.S. that carry some risk. But taking out the fallopian tubes during these procedures can add ovarian cancer prevention without needing separate medical attention. Surgeons think this is the best thing to do for their patients.

Right now, surgery is the best way to lower the risk of ovarian cancer. Ultrasound and other imaging methods are helpful for looking at the uterus and ovaries, but not for seeing the fallopian tubes. Also, cancer cells from the tubes can move around when they are very small. We would need special technology to look at the tubes and find these early signs of cancer.

Finding a biomarker for early disease is hard. Current biomarkers can only be seen in the bloodstream after cancer has spread really far. Early disease spreads through cells from the fallopian tubes onto organs and tissues in the abdominal cavity, not through the blood. So, testing for blood biomarkers might not work.

Taking out the fallopian tubes has no negative effects after child-bearing and doesn't add much risk or time to surgery. It's been a standard practice in British Columbia for over 10 years. Research shows it could reduce ovarian cancer cases. This practice has no lasting impact after child-bearing. Including it in other surgeries could help even more people. It's a major focus of continued research.

It's important for people to have control over their health, especially in preventing a cancer without proper screening or cure. Surgery options like salpingectomy are being offered to more patients to help prevent ovarian cancer. This technique can be extended beyond gynecological procedures to other forms of surgery like hernia repair and gallbladder surgery. By offering this option to hundreds of thousands of patients undergoing abdominal surgery each year, we can save lives and potentially eradicate ovarian cancer.

The blog section is an opinion and analysis article. The views expressed might not be Scientific American's.

Joseph V. Sakran is a surgeon and nurse at the Johns Hopkins Hospital. He's also a vice chair. He has several degrees: M.D., M.P.H., and M.P.A. He's a member of the American College of Surgeons. You can follow him on Twitter @JosephSakran.

Kara Long Roche works at Memorial Sloan Kettering Cancer Center. She is an associate attending and a member of the Section for Ovarian Cancer Surgery in the Department of Surgery, Gynecology Service. Long Roche has an M.D. and an M.Sc. degree. She is also a fellow of the American College of Obstretrics and Gynecologists. You can follow her on Twitter @KaraLongRoche.

Rebecca Stone is a director at the Johns Hopkins Hospital. She's an associate professor and specializes in gynecologic oncology. She's accomplished and holds an M.D. and M.S. degree. The American College of Obstretricians and Gynecologists awarded her the fellowship title.

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