Doctors in B.C. want to completely change the way that hysterectomies are performed, in hopes of preventing more women from dying from ovarian cancer.
They're asking B.C. gynecologic oncologists to fully remove the Fallopian tubes when performing hysterectomies or certain types of tubal ligation, instead of leaving them in as they usually do.
The doctors say the new approach could be a key way to prevent ovarian cancer, perhaps cutting deaths by anywhere from 30 to 50 per cent.
The new advice stems from recent research from the Ovarian Cancer Research Program at Vancouver General Hospital and the B.C. Cancer Agency. Scientists there have found that the majority of high grade "serous" ovarian tumours -- the most common and most deadly form of ovarian cancer -- actually begin in the Fallopian tube, not the ovary.
That data was published in 2009 in the International Journal of Gynecological Cancer.
There are about 50,000 hysterectomies performed each year in Canada, usually for non-cancerous reasons such as uterine fibroids or heavy menstrual bleeding.
Tubal ligations are also a common surgery, and are performed as a permanent contraceptive method. The tubes are cut and tied so that sperm can't travel through them to reach an egg.
Recent research reveals that 18 per cent of B.C. women who developed ovarian cancer had undergone a prior hysterectomy in which their Fallopian tubes were left intact. The doctors believe that many of those cancers might have been prevented if the women's tubes had been removed.
"We can have an immediate impact on saving lives by removing the Fallopian tube during these routine surgeries," oncologist Dr. Dianne Miller, chair of the Gynecology Tumour Group at the B.C. Cancer Agency; said in a statement.
Dr. Barry Rosen, a gynaecologic oncologist at Princess Margaret Hospital in Toronto, says he welcomes the new recommendations.
"I think it is terrific," he tells CTV News. "First of all, they have been studying this for quite a few years and they are not the only ones that are coming to the conclusion that serous carcinoma of the ovary starts in the Fallopian tube, not the ovary. So even though we call it ovarian cancer, it probably is Fallopian tube cancer."
"I applaud the Vancouver group for taking the information and implementing it into clinical practice."
Rosen notes that removing Fallopian tubes is "not a very complicated surgical procedure."
"So women would not be undergoing any real increased risk by removing the Fallopian tube in addition to whatever else they are having done," he says.
About 2,500 Canadian women will be diagnosed with ovarian cancer this year, and 1,750 women will die of it. Part of the reason the cancer has such a high mortality rate is that the cancer is notoriously difficult to detect. Most cases produce non-specific symptoms, such as bloating and abdominal pain, so many cases are not diagnosed until they are well advanced.
Ovarian cancer survivor Sandie Gordon says before she was diagnosed with Stage 3 cancer, the only symptom she had was slight back pain.
"I actually thought it was my bad golf game because you swing and I thought I had stretched a muscle or something. That is why I actually took as long as I did to go to the doctor," she tells CTV.
"All the symptoms I had were so minor, they were so vague. There was never one specific thing that said to me, 'You have a major problem going on in your body'," she says.
Dr. Sarah Finlayson, gynecologic oncologist at VGH and the B.C. Cancer Agency, says her team estimates that if Fallopian tubes are routinely removed during hysterectomies and tubal ligations, ovarian cancer deaths could be reduced by 30 per cent, and perhaps by 50 per cent over the next 20 years. That‘s based on how many women develop "serious" ovarian tumours, as well as the number of women who have tubal ligations and hysterectomies.
The team has now developed and produced an educational DVD, which has been delivered to all gynecologists within B.C.
"A vital component of health research is the uptake of the findings. We hope that by reaching out to both the clinicians and the public, we will be able to translate our work into important changes in patient care," Finlayson said in a statement.
With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip
