Lindsay Mazepa had never heard of an opportunistic salpingectomy.
But when Mazepa was discussing her upcoming C-section for the birth of her twins, her obstetrician-gynecologist suggested the procedure instead of the tubal ligation they were already considering for family planning.
A 43-year-old mother of three in Port Coquitlam, BC, says the doctor explained at the time that the operation would
drop significantly any chance of ovarian cancer in the future.
Opportunistic surgery is the removal of the fallopian tubes in an average-risk woman who has had children and is already undergoing gynecological surgery, such as a cesarean section or surgery for endometriosis. The ovaries are left intact.
In a tubal ligation performed solely as a method of permanent birth control, the fallopian tubes are usually cut, clamped, or sealed, but not removed.
Considering I was already having surgery and she had mentioned that it would literally only be an extra 10 minute surgery, the recovery period would be exactly the same, that was really all I needed to hear that it would reduce the risk of [ovarian] cancer in the future, said Mazepa, a neuroanalytical technologist White coat, black art. (new window)
The procedure is believed to be one of the few ways to reduce the risk of ovarian cancer, which doctors say can be difficult to detect. There is no effective screening test for the disease.
About one in 75 Canadian women will be diagnosed with ovarian cancer, according to Ovarian Cancer Canada.
Early research has shown (new window) that opportunistic salpingectomy can help reduce the risk of ovarian cancer.
We now realize that the majority of ovarian cancers are a specific subtype called high-grade serous carcinoma, and the majority of these cancers actually arise in the fallopian tubes, not the ovaries. said Dr. Janice Kwon, a gynecologist with Vancouver General Hospital and BC Cancer, and vice director of the Department of Obstetrics and Gynecology at the University of British Columbia.
Opportunistic patient training (new window) has been done in Canada for more than a decade on women who have had children and are already undergoing gynecological surgery.
BC has led the country in the number of opportunistic salpingectomies performed.
Preliminary data analyzed by University of British Columbia obstetrics and gynecology Gillian Hanley and colleagues show that utilization has grown from previous (new window) view data from all provinces except Quebec from 2011 to 2016.
It looks like rates are going up in other provinces, which is great, Hanley said White coat, black art (new window). “But it can definitely be done better.”
In the past, rates were very low, less than one in 10, in several marine areas. Now in Nova Scotia, Hanley said nearly half of tubal sterilizations are opportunistic patient studies.
Hanley said she would like to see more uptake in PEI, Newfoundland and Labrador, Ontario and Manitoba, saying opportunities to save lives are being missed.
A Canadian discovery
Dr. Dianne Miller, associate professor emerita at UBC’s Department of Obstetrics and Gynecology, was the first to develop and name opportunistic salpingectomy (new window) as a method to prevent ovarian cancer.
In 2010, an educational campaign was launched in BC to explain the benefits of opportunistic surgery.
Before 2010, says Kwon
a very small proportion of women have their fallopian tubes removed, sometimes to prevent an unplanned pregnancy or during a hysterectomy for non-cancer reasons, such as abnormal bleeding or endometriosis.
Since then, several organizations in Canada and elsewhere have made recommendations for those at average risk of ovarian cancer to consider entering an opportunistic patient program.
Last February, the nonprofit International Ovarian Cancer Research Alliance and the American Gynecologic Oncology Society released a joint statement. (new window) encouraging women undergoing pelvic surgery to have their fallopian tubes removed.
Hanley said BC’s approach to opportunistic salpingectomy was recommended in nine other countries. Scientists in the Netherlands (new window) It found that when healthcare providers offered patients the procedure, nearly 96 percent chose to go ahead.
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The procedure takes less than 15 minutes and is
very very safe said Dr. Raz Moola, an obstetrician and gynecologist based out of Kootenay Lake Hospital. He routinely performs the procedure, but said he is up with his patients about what it can and can’t do.
It is important from my point of view to be clear with the patients that this operation is ideally intended to prevent something from happening but we really don’t know that it will happen, he said, adding that fallopian tube cancer is one of about 20 different types of ovarian cancer.
Potential to reduce risk
Donna Pepin was diagnosed with ovarian cancer in 2006, which recurred a decade later.
Pepin remembers attending the 2010 event when gynecologists in B.C (new window)encouraged women at average risk to undergo opportunistic surgery.
I remember at the time being so emotional because I thought you knew the lives that could potentially be saved, the suffering that could be avoided. For me, this was a really big moment of understanding, especially after going through my own journey with ovarian cancer.
Pepin has participated in clinical trials, undergone several rounds of chemotherapy and undergone surgery.
For nine years she was healthy. But in 2016, she was diagnosed with low-grade ovarian cancer, a rare type.
The 65-year-old takes medication that has made her disease stable.
An Ovarian Cancer Canada volunteer says it’s been exciting to see the medical community making progress in ovarian cancer prevention.
As an ovarian cancer patient, our whole community would agree that this is amazing just to be able to prevent this from happening because there is no pap test. There is no way to diagnose our disease. There is no way to prevent it that we are aware of other than this one, opportunistic salpingectomy.
On top of that, other health conditions can cause the same symptoms (new window) as ovarian cancer, according to the Canadian Cancer Society website.
Also, Kwon says, the majority of women are diagnosed with advanced stage ovarian cancer where the cancer has spread (also known as metastasis) to other parts of the body.
This will be difficult to treat and cure, she said.
Since the educational campaign for opportunistic salpingectomy only began a little over 10 years ago, it’s still too early to tell what the true benefits of this procedure are, Kwon says.
But she adds to early research
Research from Hanley, Kwon and colleagues published in the peer review (new window) The Journal of the American Medical Association last year found that opportunistic patient studies could help reduce the number of cases of ovarian cancer.
Ovarian cancer is something I see almost daily…and any chance we have to prevent ovarian cancer is certainly worth it.- Janice Kwon
They found that nearly 26,000 subjects who underwent opportunistic hysterectomy had significantly fewer serous and epithelial ovarian cancers than expected, compared with the rates among controls who underwent either hysterectomy or tubal ligation.
When they looked specifically at high-grade serous carcinoma, not a single case was found among those who had their fallopian tubes removed.
Ovarian cancer is something I see almost every day. I have treated hundreds of women with that disease and any chance we have to prevent ovarian cancer is certainly worth it, Kwon said.
Stephanie Dubois (new window) · CBC radio
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