Removing Fallopian tubes during hysterectomies cuts ovarian cancer – B.C. study

In a dramatic development, B.C. scientists say that deaths from ovarian cancer could fall by as much as 50 per cent if women getting routine hysterectomies or tubal ligations have their Fallopian tubes removed too, unlike current practice which is to leave them intact.

 About 50,000 hysterectomies are done each year in Canada, and fewer tubal ligations. According to the B.C. government, there were about 4,700 hysterectomies done last year in B.C. and 2,112 tubal ligations. They are some of the most common operations performed, after caesarean sections. Hysterectomies involve the removal of the uterus and are usually done for benign (non-cancerous) reasons like heavy bleeding or uterine fibroids. Tubal ligations are permanent contraceptive procedures in which the Fallopian tubes are cut and tied so that sperm can’t travel through them.

 As a result of the discovery that many of the most deadly – and most common – ovarian tumours (high grade serous tumours) actually originate in the lining of the Fallopian tubes, the team of gynecological oncologists from Vancouver General Hospital and the BC Cancer Agency are now pleading with surgeons in B.C., Canada – and all over the world – to heed their call to remove the Fallopian tubes during the routine operations.

A statistically significant drop in ovarian cancers is expected within 10 years once surgeons make the change, experts say, but it will take about 20 years to realize the 50 per cent reduction in ovarian cancer mortality rates.

Dr. David Huntsman, an ovarian cancer expert at the BC Cancer Agency (BCCA), said in an interview that the first “wacky and arcane” suggestion about the connection between Fallopian tubes and ovarian cancer dates back to a case report in 1896. But it was a group of Ovarian Cancer Research Program scientists here that pushed the concept of actually changing surgical practices, after their close probing of cases showed that 18 per cent of women who developed ovarian cancer had intact Fallopian tubes after hysterectomies.

That finding yielded a “eureka moment” according to Dr. Dianne Miller, chair of the BCCA gynecology tumour group, because it showed that leaving behind the Fallopian tubes, which surgeons did as a matter of routine, was actually raising the risk for ovarian cancer.

“We realized that we could save lives by removing the Fallopian tubes during these surgeries,” she said in an interview.

 Huntsman explained that Fallopian tubes have been left intact because of “surgical convenience” or the notion that it was more minimally invasive. “As well, there was some concern that if you remove the tubes, you would be interfering with the blood supply to the ovaries, but that hasn’t proven to be an issue,” Huntsman said.

The local team has predicted that the mortality rate from ovarian cancer could drop by 50 per cent over the next 20 years, based on a statistical analysis of how many women get the most deadly form of ovarian cancer as well as the number of women who have tubal ligations and hysterectomies.

The pleading follows previous groundbreaking research by the same team that showed that ovarian cancer — which has a more than 50 per cent mortality rate — actually has five different subtypes.

Although it is the fifth deadliest cancer in women in Canada, it is still relatively rare as only 2,500 women are diagnosed with it each year across the country.

The recommendation to surgeons performing such operations does not affect their practice of leaving ovaries intact in women when doing hysterectomies for benign (non-cancerous) reasons like heavy bleeding and uterine fibroids, since research has shown that preserving the ovaries may confer advantages to the heart, brain and other organs. In women who have a known genetic mutation predisposing them to breast or ovarian cancer, the ovaries and Fallopian tubes are removed.

“Nobody has ever thought this out before,” said Miller, referring to the fact that the B.C. team is the first to advocate the change around the world.

“It’s already changed our practise in Vancouver but now we are rolling it out across B.C and then across Canada. It will become the new standard of care when we disseminate our knowledge and provide the evidence,” she said, noting that with donor funds from the VGH and UBC Hospital Foundation, the team has made an educational DVD which is being delivered to all gynecologists in B.C.

Health minister Kevin Falcon said in a news release that B.C. residents should feel proud about the discovery.

“This is a 100 per cent B.C.-led initiative that will have a significant positive impact on the health of women across our province, country and globally as well.”

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