By Carlos A. Herrera, M. D.
On November of 2013, the Society of Gynecological Oncology published a Clinical Practice Statement for Ovarian Cancer Prevention. In this statement, it is noted that salpingectomy, the removal of the fallopian tubes, may be the most appropriate and feasible as a strategy for ovarian cancer risk reduction.
Several medical publications have noted that the most common type of ovarian cancer the serous carcinoma has its origin in pre-malignant cells in the fallopian tube. In BRCA1 and BRCA2 mutation carriers, which convey a high risk for the development of breast and ovarian cancer (serous ovarian cancer), surgical removal of the fallopian tubes and ovaries has been shown to reduce the risk of developing, and dying from, ovarian cancer.
Since the occult lesions responsible for the developments of the serous ovarian carcinoma are in the fallopian tube, well, removing such tubes would be an essential component to ovarian cancer risk-reduction. Approximately one third of women who are BRCA mutation carriers choose not to undergo risk-reducing salpingo-oophorectomy (the removal of the tubes and ovaries) or to delay this surgery to avoid the quality of life and health risks associated with premature menopause.
The best option here would be to counsel these women to have the fallopian tubes removed after they have finished having babies, and to remove the ovaries at a later time.
The big concern though is that not removing the ovaries would still keep the patient at risk for developing ovarian cancer. This is because about 15% of the serous ovarian cancers, develop from the peritoneum, which covers the surface of the ovaries like a thin skin over them.
Even more, women who delay the removal of their ovaries would not benefit from the 50% risk reduction in breast cancer provided through the removal of the ovaries in the premenopause. These women have a significant lifetime breast cancer risk.
When removing the ovaries and tubes, close attention should be paid to the fimbriae of the tubes to detect the precancerous cells in them.
For women in the average population, who still carry a 1 in 70 risk of developing ovarian cancer in their lifetime, the removal of the tubes should be considered (after completion of childbearing) at the time of hysterectomy, or instead of a tubal ligation, and also at the time of any other type of pelvic surgery. The fallopian tubes should be examined in full, with special attention to the fimbriae of the tubes.
In summary, women who have BRCA1 and BRCA2 germline mutations should be counseled regarding the removal of both tubes and ovaries, after completion of childbearing, as the best strategy for reducing their risk of developing ovarian cancer. In the event that these women want to delay the removal of their ovaries, they should still consider removing their tubes once they have completed their family and followed by removing their ovaries at a later time, during premenopause or menopause.
The pathologist should examine the tubes and ovaries in detail to be able to detect the pre-cancerous cells present in the tubes and ovaries.
For the average woman, who has also a risk of ovarian cancer, lifetime risk of 1 in 70 or 1.4%, risk-reduction surgery by removing the tubes at the time of abdominal or pelvic surgery, hysterectomy or instead of a tubal ligation.
The above is taken from the November 2013, SGO Clinical Practice Statement by Carlos A. Herrera, M.D.
Dr. Carlos A. Herrera, M.D., F.A.C.O.G., is a Mega Doctor News Guest Writer; he is a Fellow of the American College of Obstetricians and Gynecologists and we are proud and welcome him.