A preventative surgical procedure developed in British Columbia appears to drastically reduce a woman’s risk of developing the most common and deadly form of ovarian cancer, a merciless disease of which half of the victims will survive at most five years after diagnosis.

Opportunistic salpingectomy involves the proactive removal of the fallopian tubes of a woman who is already undergoing a routine gynecological procedure, such as a hysterectomy or tubal ligation.

Women who underwent this procedure were subsequently 78 per cent less likely to develop ovarian cancer, reveals a research letter recently published in the medical journal JAMA Network Open. And in the rare cases where the disease did occur, it was biologically less aggressive.

“There is no such thing as a pleasant cancer, but ovarian cancer is a very nasty disease,” commented Dr. Lucy Gilbert, director of the Division of Gynecological Oncology and the Women’s Health Research Unit at the McGill University Health Centre.

“We can do prevention, at best we can offer surgery and removal, but when we are faced with an advanced disease, it becomes very difficult.”

Logically, experts have long looked for the origin of ovarian cancer directly in the ovaries, Dr. Gilbert indicated.

However, it was realized several years ago that “the vast majority of ovarian cancers, serous ovarian cancers, originate in the fallopian tubes,” rather than the ovaries, she added.

“The poor ovary is innocent,” said Dr. Gilbert. “I made that mistake too, and we were fools. We wasted a lot of time trying to detect ovarian cancer through imaging.”

An examination of the ovaries and even the fallopian tubes of a woman who is showing the first symptoms of ovarian cancer will not reveal anything abnormal, she added, “but it is believed that this small cancer is already hidden in the abdomen. We were simply looking in the wrong place.”

“We were interested in something innocent, while the culprit had started spreading cancer cells everywhere even though he seemed to be in perfect health,” said Dr. Gilbert.

Opportunistic salpingectomy was developed by a team of researchers from the University of British Columbia, BC Cancer, and Vancouver Coastal Health. In 2010, the province became the first jurisdiction in the world to offer this procedure, which is now recommended by medical organizations in 24 countries.

Opportunistic salpingectomy has the advantage of protecting the integrity of the ovaries, thereby preserving the production of important hormones and minimizing the side effects associated with this additional intervention.

The new study is the first to quantify the reduction in ovarian cancer risk associated with opportunistic salpingectomy. Its findings stem from an analysis of health data from a population of over 85,000 people who underwent gynecological surgery in British Columbia between 2008 and 2020. Researchers compared the rates of serous ovarian cancer between people who underwent opportunistic salpingectomy and those who underwent similar surgeries, but without this procedure.

“We can truly be proud that the basis of this study is Canadian,” commented Gilbert. “It’s an excellent idea. Since we can’t detect these cancers very early with the tools we have, why not take advantage of another surgical procedure to remove the fallopian tubes?”

The goal, she said, is obviously not to start “harassing all women to have their fallopian tubes removed.” But since surgery is inherently a serious procedure, “if we’re going to enter someone’s abdomen anyway to ligate their tubes, why not just remove them?” she asked.

“We might as well take this opportunity to do something that will reduce the risk of the eighth or ninth most common cancer in women,” Dr. Gilbert emphasized.

It goes without saying that the woman must be certain that she never wants children again, but the question does not really arise if the patient was already going to have a hysterectomy or tubal ligation, she stressed.

The downside is that it is a longer and more complex procedure, there is also concern about interfering with the blood supply to the ovaries and menopause could come a little earlier, “but in life you have to weigh the pros and cons, and ultimately, I think it’s a brilliant idea, the benefits are so much greater,” applauded Dr. Gilbert.

Ovarian cancer is the deadliest gynecological cancer. Approximately 3,100 Canadian women are diagnosed with this disease each year, and about 2,000 die from it.

There is currently no reliable screening test for ovarian cancer, which means that most cases are diagnosed at an advanced stage, when treatment options are limited and survival rates are low.

–This report by La Presse Canadienne was translated by CityNews