Women at high risk of ovarian cancer should consider removal of fallopian tubes, experts say


“Knowledge is power,” says 26-year-old Samantha Carlucci. The Ravena, New York resident recently underwent a hysterectomy which included the removal of her fallopian tubes – and believes it saved her life.

Experts draw attention to the role of the fallopian tubes in many cases of ovarian cancer and say more women should consider removing them to reduce their cancer risk.

About 20,000 women in the United States were diagnosed with ovarian cancer in 2022, according to the National Cancer Institute, and nearly 13,000 died.

Experts have not discovered a reliable screening test to detect the early stages of ovarian cancer, leading them to rely on knowledge of symptoms to diagnose patients, according to the Ovarian Cancer Research Alliance.

Unfortunately, symptoms of ovarian cancer often only show up when the cancer has progressed, causing the disease to go undetected and undiagnosed until it progresses to a later stage.

“If we had a test to detect ovarian cancer at an early stage, patient outcomes would be significantly better,” said Dr. Oliver Dorigo, director of the gynecological oncology division in the department of obstetrics. and Gynecology from Stanford University Medical Center.

Until such a test becomes widely available, researchers and advocates suggest another way to reduce the risk: opportunistic salpingectomy.

A salpingectomy, the surgical removal of both fallopian tubes, may be a good option for women at high risk for ovarian cancer. Several factors can increase this risk, including genetic mutations, endometriosis or a family history of ovarian or breast cancer, according to the US Centers for Disease Control and Prevention.

Research has found that nearly 70% of ovarian cancers start in the fallopian tubes, according to the Ovarian Cancer Research Alliance.

Doctors are now advising more high-risk women to have a salpingectomy if they agree that they cannot get pregnant afterwards and if they are already considering having pelvic surgery, making it “opportunistic”.

“We’re really talking about cases where a surgeon would already be in the abdomen anyway,” such as during a hysterectomy, said Dr. Karen Lu, professor and chair of the Department of Gynecological Oncology and Reproductive Medicine at the MD Anderson Cancer Center.

Fallopian tubes are typically 4 to 5 inches long and about half an inch thick, according to Dorigo. During an opportunistic salpingectomy, the two tubes are separated from the uterus and a thin layer of tissue that runs along them from the uterus to the ovary.

The procedure can be performed laparoscopically, with a thin instrument and a small incision, or open surgery, which involves a large incision through the abdomen.

The procedure adds about 15 minutes to any pelvic surgery, Dorigo said.

Unlike a total hysterectomy, in which a woman’s uterus, ovaries, and fallopian tubes are removed, removing the tubes themselves does not affect the menstrual cycle and does not initiate menopause.

The risks associated with an opportunistic salpingectomy are also relatively low.

“Any surgery has risks…so you don’t want to walk into an operation mindlessly,” Lu said. it is minimal.”

Many women who have had the procedure say the benefits far outweigh the risks.

Carlucci had her fallopian tubes removed in January during a total hysterectomy, after testing positive for a genetic condition called Lynch syndrome that increased her risk of many types of cancer, including in the ovaries.

Several members of her family died of colon and ovarian cancer, she said, and that prompted her to consider the options available.

Samantha Carlucci recently underwent a hysterectomy which included the removal of her fallopian tubes.

Knowing that she could choose an opportunistic salpingectomy, which significantly reduced her risk of ovarian cancer, gave her hope.

As part of the total hysterectomy, she eliminated her risk of ovarian cancer.

“You can’t change your DNA, and no amount of diet, exercise, or medication is going to change it, and I felt horrible,” Carlucci said. “When I learned that this would 100% prevent me from having to deal with ovarian cancer in my body, that was good to hear.”

Carlucci urges any woman at medium to high risk for ovarian cancer to talk to her doctor about the procedure.

“I know that sounds scary, but it’s something you should do, or at the very least think about,” she said. “It can bring so much relief to know that you have made the choice to keep yourself here as long as possible.”

Monica Monfre Scantlebury, 45, of St. Paul, Minnesota, underwent a salpingectomy in March 2021 after witnessing a breast and ovarian cancer-related death in her family.

In 2018, Scantlebury’s sister was diagnosed with stage IV breast cancer aged 27.

“She continued to battle breast cancer,” Scantlebury said. “At the start of the pandemic, in March 2020, she actually lost her battle with breast cancer at age 29.”

During this period, Scantlebury herself discovered that she was positive for BRCA1, a genetic mutation that increases the risk of breast cancer by 45% to 85% and the risk of ovarian cancer by 39% to 46%.

After meeting with her doctor and discussing her options, she decided to have a salpingectomy.

Her doctor told her she would remove the fallopian tubes and anything else of concern she found during the procedure.

“When I woke up from surgery she said there was something in my left ovary and she removed my left ovary and my fallopian tubes,” Scantlebury said.

Her doctor called about a week later and said there had been cancer cells in her left fallopian tube.

The salpingectomy had saved his life, the doctor said.

“We don’t have an easy way to be diagnosed until it’s almost too late,” said Scantlebury, who later underwent a full hysterectomy. “It really saved my life and potentially gave me decades back that I might not have had.”

Audra Moran, President and CEO of the Ovarian Cancer Research Alliance, sends a message to women: Know your risk.

Moran believes that if more women had the power to know their risk for ovarian cancer, more lives would be saved.

“Look at your family history. Do you have a history of ovarian, breast, colorectal or uterine cancer in your family? On both sides, man or woman, father or mother? said Morane. “If the answer is yes, then I would recommend talking to a doctor or talking to a genetic counselor.”

The alliance offers genetic testing resources on its website. According to the United States Bureau of Labor Statistics, a genetic counselor assesses the risks of various cancers based on inherited conditions.

Carlucci and Scantlebury agree that understanding risk is key to preventing deaths in women.

” This is my story. It’s his story. This is my sister’s story… This is for all women,” Scantlebury said.

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