New WCH study looks at the link between removal of the fallopian tubes and this deadly disease
A new study by researchers at Women’s College Hospital suggests that a procedure increasingly considered for permanent contraception may help to reduce the risk of ovarian cancer.
Although relatively rare, ovarian cancer has a very high mortality rate and is the fifth leading cause of cancer deaths among women in Canada.
The high-mortality rate combined with little progress in screening for early detection and poor quality of life for survivors, make this disease a pressing health issue.
“Primary prevention with surgery is only indicated for women at the highest risk developing ovarian cancer, for example, women with a genetic predisposition,” says Joanne Kotsopoulos PhD, Scientist at the Women’s College Research Institute, and Canada Research Chair in Hereditary Breast and Ovarian Cancer Prevention. “Given the lack of effective screening methods or primary prevention options for women in the general population, any interventions that may lower the risk and reduce the number of cases and death, are beneficial.”
A growing body of scientific evidence supports the notion that a subset of ovarian cancers actually begin in the fallopian tubes. It’s suggested that the removal of the fallopian tubes at the time of another abdominal surgery or instead of tubal ligation may offer healthcare providers the opportunity to decrease the risk of ovarian cancer in women from the general population.
In their recent population-based study, Kotsopoulos and her team evaluated the association between fallopian tube removal (salpingectomy) and risk of ovarian cancer, among 131,516 women from Ontario.
Among the findings published in JAMA Open, researchers saw a substantial 45 per cent reduction in the risk of developing ovarian cancer among women who had both fallopian tubes removed (bilateral salpingectomy) compared to those who did not have a pelvic procedure. The results build on those from earlier observational studies which collectively suggested a 49 to 65 per cent reduction in risk.
The team also confirmed an increase in the rates of salpingectomy in Ontario since 2010 both in lieu of tubal ligation for contraceptive purposes, and opportunistically, when the tubes are removed while patients are having pelvic surgery for another reason, such as a hysterectomy or C-section.
“The use of validated, provincial administrative databases that leverage information like physician billing codes for a large population is what sets our study apart from previous work,” says Vasily Giannakeas PhD, Cancer Epidemiologist and postdoctoral fellow at the Women’s College Research Institute. “Additionally, we observed consistent findings using a robust statistical approach, which suggests biases in the results are less likely.”
However, given how rare ovarian cancer is, and the relatively short follow-up period in this study, more research with added years of follow up are needed to further define the link between salpingectomy and a reduced risk of ovarian cancer.
“Ultimately, this study suggests that if the removal of healthy fallopian tubes truly reduces the risk of ovarian cancer, future studies with longer follow up should reveal a statistically and clinically meaningful decrease in cases,” says Kotsopoulos.
“The safety and acceptability of this procedure is established,” she adds, “with clinical practice guidelines now recommending salpingectomy over tubal ligation for contraception or at the time of another procedure.
“The evidence strongly points to offering bilateral salpingectomy to women at average risk of developing ovarian cancer with the aim of preventing the most aggressive form of this rare but fatal disease.”