Because there is no reliable screening test for ovarian cancer, doctors advise women at high genetic risk for the disease to have their ovaries and fallopian tubes removed after having children, usually around age 40. .
On Wednesday, a major research and advocacy group extended its recommendations in a way that may surprise many women.
Based on the evidence that most of these cancers arise in the fallopian tubes, not the ovaries, the Ovarian Cancer Research Alliance has decided that even women who do not carry the mutation, meaning most women, will have their fallopian tubes surgically removed when finished. I encourage you to I have a child and am planning a gynecological surgery anyway.
In such procedures, the surgeon removes the tube from the ovary to the uterus, but leaves the ovary intact.ovaries make hormones It is also beneficial later in life, reduce the risk of heart disease, osteoporosis and sexual dysfunction. Organ preservation is associated with lower overall mortality.
“Ovarian cancer is a relatively rare disease that usually doesn’t send a message to the general public,” said Audra Moran, OCRA’s president and CEO. “I want everyone with ovaries to know their risk level and what actions they can take to help prevent ovarian cancer.”
To that end, the group We have also started offering free home test kits. To eligible women who want to know if they have genetic mutations such as BRCA1 and BRCA2 that increase the risk of developing both ovarian and breast cancer.
Young carriers of the mutation may consider removing only the fallopian tubes as an interim step to protect against ovarian cancer and avoid sudden premature menopause, Moran said. . .
Women with BRCA1 and BRCA2 mutations are at very high risk of ovarian cancer, but the majority of women with this disease do not carry the mutations.
The new advice acknowledges that efforts to develop life-saving screening tests for early detection of ovarian cancer have failed and that women should consider more aggressive measures.
In a large clinical trial in the UK, Imaging scans and blood tests for early detection of ovarian cancer The cancer was not detected early enough to save lives.
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women are Told to watch out for vague symptomslike bloating, could indicate something is wrong, but experts say there is no evidence that vigilance prevents death, as symptoms typically appear late in the course of the disease. say.
The Society of Gynecologic Oncology, an organization of physicians who treat gynecologic cancers, has endorsed a new push to make genetic testing more accessible and promote preventive removal of fallopian tubes in women without genetic risk. .
“It’s considered experimental,” said Dr. Stephanie Blank, president of the association. But “it makes scientific sense and has a lot of appeal.”
“Removing a tube isn’t as good as removing a tube and an ovary, but it’s better than a screening that goes wrong,” she said.
said Bill Dahut, Ph.D., chief scientific officer of the American Cancer Society (ACS). the following. “
“From a biological point of view, maybe we should call it fallopian tube cancer and think about it differently, because that’s where it starts,” he said.
According to ACS, ovarian cancer ranks fifth in cancer deaths in women, accounting for more deaths than any other cancer of the female reproductive system.some every year 19,710 women in the United States are diagnosed with ovarian cancer About 13,000 women have died.
The disease is a particularly obscure malignancy and as a result is often diagnosed at a very advanced stage. Ovarian cancer is much less common than breast cancer, which is diagnosed in 264,000 women and her 2,400 men in the United States each year, but it has a much lower survival rate.
In women with BRCA1 and BRCA2 gene mutations, surgeons commonly remove the ovaries and fallopian tubes — between the ages of 35 and 40 in women with BRCA1 mutations and between the ages of 40 and 45 in women with BRCA2 mutations. said Dr. Blank. Ideally, the woman should have completed childbirth by then.
However, women without a clear family history of ovarian or breast cancer may not be aware that they carry the mutation.
Monica Monfre Cantlebury, 45, of St. Paul, Minnesota, discovered she had the BRCA1 mutation in 2017 when her sister was diagnosed with metastatic breast cancer at age 27.
Their mother had no mutation. In other words, it was inherited from a deceased father. His mother, Scantlebury’s grandmother, died of breast and ovarian cancer in her 40s.
In the family, heart disease was discussed, but cancer in women was only whispered, she recalled in an interview. I had an ovary removed that I thought was
“I was in my early 40s, and doctors were less concerned about my having breast cancer at that point and more concerned about my increased risk of ovarian cancer,” she said. rice field.
A few days later, she got a call from her doctor who said they had found cells in one of the removed fallopian tubes that she thought were precursors to high-grade serous ovarian cancer. Scantlebury decided to remove her uterus and cervix, as well as her remaining right ovary.
Those decisions weren’t easy. “I made the choice not to have a biological child, and it was tough,” she said. “And I’m still at risk for breast cancer.” was named after my grandmother.
The practice of removing the fallopian tubes while a patient is already undergoing another pelvic surgery, called opportunistic salpingectomy, is already standard practice in British Columbia, according to the state’s gynecologist until recently. Dianne Miller, M.D., a cancer service leader, said.
“Fifteen years ago, it became clear that the deadliest and most common type of high-grade cancer actually starts in the fallopian tubes, not the ovaries, and spreads very quickly,” said Dr. Miller. said.
By the time women experience symptoms such as bloating and abdominal pain, it’s too late to do anything to save their lives, she said.
“I remember the moment the light bulb went off that many of these cancers are probably preventable because many women will have surgery at some point to have a hysterectomy, fibroid removal, or tubal ligation. said Dr. Miller.
Removing the ovaries during a hysterectomy was once routine. By doing so, the risk of breast cancer is reduced and ovarian cancer is almost eliminated. For high-risk women, it remains the preferred option.
But for women at average risk of ovarian cancer, removing only the fallopian tubes is a “win-win” situation, as the intact ovaries continue to produce the brain and small amounts of hormones that help maintain it. can also reduce the risk of ovarian cancer, Dr. Miller said. heart healthy later in his life.
“As oncologists, we are looking to cure cancer,” Dr. Miller said. “But if there’s one thing that’s absolutely better than curing cancer, it’s not curing cancer in the first place.”
