Western Regional Blog – BC, YK, AB, NWT and Nunavut
A pioneering, B.C.-led surgical procedure aimed at preventing ovarian cancer has been deemed safe by a new Italian study published Thursday in the medical journal Gynecologic Oncology.
B.C. experts have been at the forefront of a change in surgical protocols that recommends the removal of women’s Fallopian tubes during hysterectomies in order to reduce their risk of developing ovarian cancer.
But, as a Vancouver Sun series published earlier this year showed, preventive Fallopian tube removal has been controversial because of concerns on the part of some surgeons that there is no proof that removing the tubes won’t compromise biological functions or pose undue surgical risks.
The new Italian study found no negative effects of the procedure, prompting the authors to note that because of the “reassuring data, it could be possible for our group to start a preventive campaign in South Italy, following the example of British Columbia.”
They also questioned whether it is ethical to not inform patients about the simple ovarian cancer prevention strategy.
“Considering that in developed countries, hysterectomy is the second most frequently performed surgical intervention among women of reproductive age … it is clear that a strong rationale exists to justify the British Columbia Ovarian Cancer Prevention Project. It encourages (preventive Fallopian tube removal) and estimates up to 50-per-cent reduction in ovarian cancer deaths after 20 years.”
B.C. is believed to be the first jurisdiction in the world to recommend the preventive procedure for all women undergoing hysterectomies or surgical sterilization (tubal ligation), based on research showing that ovarian cancer most often starts in the nearby ends of the Fallopian tubes. Removing the tubes while women are undergoing other gynecologic surgery could help reduce the risk of developing ovarian cancer.
Since B.C. ovarian cancer experts made their recommendation in 2010, there has been a 20-fold increase in such procedures.
Although the Italian study is relatively small (158 patients), it found that women who had their tubes removed did not spend more time in the operating room nor in the hospital recovering. Their return to normal activity was also the same as women who had hysterectomies in which tubes were left in.
The researchers from Magna Graecia University compared data on women in two groups — 79 patients who had Fallopian tubes removed at the same time as their hysterectomies, compared to 79 patients who had hysterectomies but kept their tubes. They found that adding Fallopian tube removal to hysterectomy procedures for prevention of ovarian cancer had no negative effects, vindicating the B.C. recommendations.
The role of the Fallopian tube is to facilitate conception, and then transport the egg and sperm. The adjacent ovaries, however, play a more important, ongoing, role in the lives of women. Preservation of ovaries, especially in pre-menopausal women, has been shown to have cardiovascular, cognitive, bone and psychosocial health benefits.
In the case of women like actress Angelina Jolie, who have a genetic defect that predisposes them to both breast and ovarian cancer, doctors usually recommend preventive removal of the breasts and then later removal of ovaries and tubes, closer to the age of natural menopause. Jolie has said she is planning to have an oophorectomy (ovary removal), and presumably it would include the Fallopian tubes.
Also in its recent June issue, the medical journal published a guest editorial by a pair of Vancouver experts — doctors Dianne Miller and Blake Gilks — who were part of the team that came to prominence for issuing the new protocol recommendation three years ago.
They say that the new study helps demonstrate that there are no “detectable complications of performing (tube removal) at the same time as hysterectomy”.
About 50 per cent of gynecologists now discuss the option of Fallopian tube removal with their pre-menopausal patients during the pre-hysterectomy stages, the doctors note.
Vancouver Sun Health Issues Reporter