Ovarian Cancer Prevention
- The Ovarian Cancer Research Alliance recommends people who are at an average risk of ovarian cancer consider having an “opportunistic salpingectomy” the removal of their fallopian tubes if they’re already undergoing a pelvic surgery.
- Two of our experts agree with this recommendation because we don't yet have a good test to detect ovarian cancer before it spreads, and the disease most often begins in the fallopian tubes.
- In addition, one of our experts note that a prophylactic [preventative] bilateral salpingectomy-oophorectomy the removal of both the fallopian tubes and the ovaries is recommended for most women “who carry germ line mutations or who have a strong family history of breast or ovarian cancer.”
In a recently released statement from the Ovarian Cancer Research Alliance, the nonprofit encourages women at average risk of ovarian cancer “who are undergoing pelvic surgeries for benign conditions (hysterectomy, tubal ligations, cysts, endometriosis) to consider having their fallopian tubes removed. As the fallopian tube is the origin of most high-grade serous cancers, fallopian tube removal has been shown to dramatically reduce risk for a later ovarian cancer diagnosis. This has been referred to as ‘opportunistic salpingectomy.'”
Read More“There are now data that show that prophylactic [preventative] bilateral salpingectomy [removal of the fallopian tubes] will reduce the risk of developing the disease in women at average risk for this cancer.”
Is There Screening for Ovarian Cancer?
Dr. Berek also said women who plan to have their “tubes tied” for permanent sterilization should also “be recommended to instead consider prophylactic bilateral salpingectomy and be counseled regarding this benefit.”
The reason for the focus on the fallopian tubes is simple.
“Most high-grade serous "ovarian cancers" actually arise in the fallopian tubes, so prophylactic removal of the tubes after a woman's childbearing has been completed is appropriate,” Dr. Berek explained. “This can be accomplished at the same time a woman is undergoing any planned abdominal operation, including cesarean section.
“Women are encouraged to discuss these options with their gynecologist, gynecologic oncologist or their general primary care or internal medicine physicians. Referral to a specialist is typically necessary.”
Dr. Beth Karlan, a renown gynecologic oncologist at UCLA Medical Center, also supports the OCRA's recommendation.
“Importantly, OCRA's message shifts the emphasis away from symptom recognition and early detection of ovarian cancer to a focus on primary prevention of ovarian cancer,” Dr. Karlan told SurvivorNet. “As Benjamin Franklin said, ‘An ounce of prevention is worth a pound of cure.'”
Ovarian Cancer Major Factors for Reducing Your Risk
Dr. Karlan continued by explaining why this surgery provides us with a unique tool for ovarian cancer prevention.
“Despite decades of laboratory research and large clinical trials, we still don't have an effective means to find ovarian cancer at an earlier more curable stageyet we do have a strategy that can reduce women's risk of getting ovarian cancer while not disrupting her ovarian function,” she said. “Opportunistic salpingectomy can prevent ovarian cancer whether or not a woman is at high risk due to a genetic predisposition such as a BRCA or other gene mutation. ”
Dr. Karlan did, however, note that this recommendation is nothing new. Though it does amplify these recommendations to a much broader audience.
“With the recognition that a majority of ovarian cancers originate in the fallopian tubes, opportunistic salpingectomy in order to reduce the risk of ovarian cancer has been recommended by the Society of Gynecologic Oncology (SGO) and American College of Obstetricians and Gynecologists (ACOG) for almost a decade,” she said. “OCRA is leading the way and disseminating information about this important strategy to empower women to discuss opportunistic salpingectomy with their doctors and determine if it's right for them.”
But this recommendation from OCRA is in addition to the ever-important role of identifying women who are predisposed to a higher ovarian cancer risk because they carry germ-line mutations like BRCA1-2. The OCRA wants people at an increased risk for the disease who are done with childbearing to consider a bilateral salpingo-oophorectomy the removal of both fallopian tubes and ovaries or a bilateral salpingectomy the removal of just the fallopian tubes to decrease their risk of the cancer. Dr. Berek breaks this down by saying the following:
“In women who carry germ line mutations or who have a strong family history of breast or ovarian cancer, prophylactic bilateral salpingectomy-oophorectomy is recommended for most of these women,” he clarified. “They are strongly urged to undergo genetic counseling and referral to a specialist, such as a gynecologic oncologist.”
Learning More about Ovarian Cancer
Ovarian cancer is when the ovaries which produce the sex hormone, estrogen, as well as eggs become cancerous. Women have two ovaries, one on either side of the uterus.
Feeling Overwhelmed by Your Ovarian Cancer Diagnosis? Here Are Some Ways to Regain Your Equilibrium
As we mentioned above, the fallopian tube which brings the egg from the ovary to the uterus for fertilization is where many ovarian cancers begin. First, a few cancerous cells develop on the fallopian tubes, then these cells stick to the ovaries as the fallopian tubes brush over the ovary. From there, the cancerous cells grow to form a tumor.
Your risk for ovarian cancer may be increased if you have gone through menopause, have a gene mutation like BRCA1 or BRCA2, are obese or overweight, had your first pregnancy after age 35 or never carried a pregnancy to full-term, have a family history of cancer or used hormone replacement therapy. You should talk with your doctor about your potential risk for the disease.
Symptoms of the Disease
Ovarian cancer is known as the cancer that whispers because symptoms are vague and sometimes similar to regular menstrual cycle fluctuations. Dr. Beth Karlan says ovarian cancer can be difficult to recognize with its subtle symptoms.
Ovarian Cancer: The Cancer that Whispers
"Ovarian cancer does not have any specific symptoms," Karlan said in an earlier interview with SurvivorNet. "It's often referred to as the cancer that whispers in that it has symptoms that are really very vague… and nothing that may bring your attention directly to the ovaries."
But Dr. Karlan still wants women to keep an eye out for a variety of possible symptoms.
"The symptoms include things like feeling full earlier than you usually would when your appetite is strong… Feeling bloated," she added. "Some changes in your bowel habits. Some pain in the pelvis. These are symptoms women may have every month. These are not very specific. But what we've found from multiple studies, it's this constellation of symptoms."
Dr. Stephanie Wethington, director of the gynecologic oncology survivorship program at Johns Hopkins Medicine, previously told SurvivorNet that prevention for ovarian cancer is an important area of focus.
"We must remember that prevention is key and advocate for all women to discuss their family history and individual risk factors with their doctors and ask whether there are risk-reducing options available to them," Dr. Wethington wrote.
Our advice to readers: See your doctor if you feel like something is off. Given that ovarian cancer can have no symptoms or a myriad of symptoms that you might easily brush off as nothing, it's important to always seek medical attention when your gut is telling you something might be wrong. That doesn't mean we should assume the worst every time we feel bloated or have a change in appetite, but it does mean we should always try to listen to the signs our body is giving us.
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