How new findings on ovarian cancer origins may help reduce risk

Geoff Bennett:

New breakthroughs are changing how doctors understand one of the deadliest cancers affecting women.

Amna Nawaz:

Researchers now know that almost all fatal ovarian cancers begin in the fallopian tubes, not the ovaries.

Stephanie Sy is back now to tell us more about how this new understanding is impacting patient care.

Stephanie Sy:

Ovarian cancer has a poor prognosis, with most women finding out about it when it's already advanced. Now cancer prevention groups are touting a relatively new prevention, removing the fallopian tubes when a patient who isn't planning to have more children may already be undergoing surgery for something else, such as a hernia repair.

One of the advocates of this approach is Dr. Rebecca Stone, a professor in the Johns Hopkins Medicine Department of Gynecology and Obstetrics.

Dr. Stone, thank you so much for joining the "News Hour."

First of all, tell me how this works and why it's so important that doctors and patients are aware of it as an option.

Dr. Rebecca Stone:

Back in the early 2000s was the discovery that the most common and deadly type of ovarian cancer actually by far and large comes from the fallopian tube.

And salpingectomy, or fallopian tube removal, decreases the risk of tubo-ovarian cancer then significantly, we know by at least 50 percent, and the data tracking out of B.C., Canada, indicate that it may be upwards of 80 percent risk reduction of the most common deadly type of ovarian cancer when you undergo fallopian tube removal.

Stephanie Sy:

So, my understanding of the way this works, Dr. Stone, is that a patient who may already have some sort of abdominal surgery they have planned, such as a C-section or a hernia repair, can then ask their doctor if they're done having children to remove the fallopian tubes, right? Why aren't more people doing this?

Dr. Rebecca Stone:

There has not been mass public awareness about this discovery and about the role of fallopian tube removal in the prevention of tubo-ovarian cancer.

And it is not a universally covered option on insurance health plans. So the average woman, person watching this news segment can't be sure that their health plan covers fallopian tube removal, for instance, as an alternative to tubal ligation, which is the most common scenario when a woman might consider fallopian tube removal.

Stephanie Sy:

Given how much it can lower risk for women, which women really should be talking to their doctors about doing this? How do you know how great a risk you're at for ovarian cancer?

Dr. Rebecca Stone:

The goal is universal awareness of this discovery and of the benefit of fallopian tube removal for tubo-ovarian cancer prevention among women who have finished childbearing or family planning, don't need fallopian tubes for future fertility, however you want to define it.

And when you think about the -- everyone, I sort of think about two groups of women, people who have average risk, so average lifetime risk of developing ovarian cancer of 1 to 2 percent. That's the general population. And then you have people who are higher than average risk, so people who have a moderate to high risk, either due to a family history of tubo-ovarian cancer or due to germ line genetic testing that has revealed a genetic change that increases someone's risk for developing the cancer over the course of their lifetime to anywhere between 5 to 40 percent in the case of women who have a BRCA1 genetic change.

Stephanie Sy:

What are the risks and/or side effects of the surgery?

Dr. Rebecca Stone:

When you choose to undergo fallopian tube removal at the time of another planned operation, the risk and the time in the operating room is already attributable to the primary operation.

So, when you have this as an add-on procedure, for instance, to a hysterectomy or hernia repair or a gallbladder removal, so this does not add substantial risk and takes on average about eight minutes, and it doesn't change recovery. The recovery is related to the primary procedure as well.

So that's why it's such a compelling prevention option for a cancer that is in the top five to six most deadly cancers that we face as a human race, a cancer for which there is no screening and no reliable treatment or cure. That's why prevention is so important.

We have really focused on ovarian removal for the prevention of tubo-ovarian cancer, what we called ovarian cancer, but that's not such a great risk reduction strategy, the idea of removing the ovaries, because the ovaries are not only a reproductive or fertility organ. They are also an endocrine organ that almost certainly have important function even after a woman goes through menopause,whereas the fallopian tube doesn't affect how we look or how we feel.

It doesn't have any known function once its role in reproduction or fertility is over.

Stephanie Sy:

Dr. Stone, how many lives might be saved if there was more awareness and insurance coverage around this option?

Dr. Rebecca Stone:

So if there was universal awareness and access to the benefit of fallopian tube removal at the time of hysterectomy, and as alternative to tubal ligation, it's projected that we would save almost 2,000 lives a year from tubo-ovarian cancer in this country.

And if care about the dollars and cents of it, that is equivalent to about half-a-billion health care dollars annually.

Stephanie Sy:

That is Dr. Rebecca Stone with Johns Hopkins University joining us.

And for more information on ovarian cancer, you can go to outsmartovariancancer.org.

Dr. Rebecca Stone:

Thank you so much for caring about this on behalf of all women.