This simple surgery could slash ovarian cancer rates in Canada, specialists say

Originally published on June 17, 2023.

Lindsay Mazepa had never heard of 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 for family planning they were already considering.  

The 43-year-old mom of three in Port Coquitlam, B.C., says her doctor explained at the time that the procedure would "significantly decrease" any chances of ovarian cancer in the future. 

Opportunistic salpingectomy is the removal of the fallopian tubes in an average-risk woman who is done having children and is already undergoing a gynecological surgery, such as a C-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 the surgery and that she had mentioned that there would be literally only a 10-minute extra procedure, the recovery period would be exactly the same, that was really all I needed to hear that it would decrease my risk of [ovarian] cancer in the future," said Mazepa, a neurodiagnostic technologist, told White Coat, Black Art.

The procedure is considered 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 that an opportunistic salpingectomy can help reduce the risk of ovarian cancer. 

"We now recognize 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 tube, not the ovary," said Dr. Janice Kwon, a gynecologic oncologist with Vancouver General Hospital and BC Cancer, and vice-head of University of British Columbia's obstetrics and gynecology department.

Opportunistic salpingectomy has been done in Canada for more than a decade on women who are done having children and are already undergoing a gynecological surgery. 

B.C. has led the country in terms of the number of opportunistic salpingectomies perfomed.

Preliminary data analyzed by University of British Columbia obstetrics and gynecology associate professor Gillian Hanley and colleagues shows that uptake has grown since their previous look at data from all provinces except Quebec from 2011 to 2016. 

"It does look like rates are increasing in other provinces, which is great," Hanley told White Coat, Black Art. "But there is still definitely room for improvement."

Previously, rates were very low, less than one in 10, in several Maritime provinces. Now in Nova Scotia, Hanley said nearly half of tubal sterilizations are opportunistic salpingectomy. 

Hanley said she would like to see higher uptake in P.E.I., 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 as an ovarian cancer prevention strategy.

In 2010, an education campaign rolled out in B.C. to explain the benefits of opportunistic salpingectomy.

Prior to 2010, Kwon says "a very small proportion of women" had their fallopian tubes removed, sometimes to prevent an unplanned pregnancy or during a hysterectomy for non-cancerous reasons, such as abnormal bleeding or endometriosis. 

Since then, several organizations in Canada and elsewhere have come out with recommendations for those with average risk for ovarian cancer to consider having an opportunistic salpingectomy.

Most recently in February, the global non-profit Ovarian Cancer Research Alliance and the Society of Gynecologic Oncology in the U.S. released a joint statement encouraging women undergoing pelvic surgeries to also have their fallopian tubes removed. 

Hanley said B.C.'s approach to opportunistic salpingectomy is recommended in nine other countries. Researchers in The Netherlands found when health professionals offered the procedure to patients, nearly 96 per cent chose to proceed.

The procedure takes less than 15 minutes and is "very, very safe," said Dr. Raz Moola, an obstetrician-gynecologist based out of Kootenay Lake Hospital. He routinely performs the surgery, but said he's up front with his patients about what it can and can't do.

"It's important from my perspective to be clear with the patients that this procedure is meant to ideally prevent something from happening but we don't actually know that it will," he said, adding that fallopian tube cancer is one of about 20 different types of ovarian cancer.

The potential to lower risk

Donna Pepin was diagnosed with ovarian cancer in 2006, which recurred a decade later. 

Pepin remembers being at the 2010 event when gynecologists in B.C. encouraged average-risk women to get opportunistic salpingectomy.

"I remember at the time I felt so emotional because I thought you know the lives potentially that could be saved, the suffering that can be avoided. For me it was this really huge moment of understanding, especially having gone through my own journey with ovarian cancer."

Pepin has taken part in clinical trials, done several rounds of chemo treatment and undergone surgery. 

For nine years she was healthy. But in 2016 she was diagnosed with low-grade serous ovarian cancer, a rare type.

The 65-year-old takes medication that has allowed her disease to remain stable.

The Ovarian Cancer Canada volunteer says it's been exciting seeing the medical science community make progress in ovarian cancer prevention. 

"As an ovarian cancer patient, all of our community would agree that this is amazing just to be able to stop it from happening because there is no pap test. There is no way to detect our disease. There's no way to prevent it that we are aware of aside from this one, opportunistic salpingectomy."

On top of that, other health conditions can cause the same symptoms as ovarian cancer, according to the Canadian Cancer Society's website.

Also, Kwon says the majority of women are diagnosed with ovarian cancer at an advanced stage where the cancer has spread (also known as metastasized) to other parts of the body. 

"This becomes difficult to treat and cure," she said.

Since the education campaign for opportunistic salpingectomy only launched just over 10 years ago, it's still early to say what the true benefits of this procedure are, Kwon says.

But she adds early research is "exciting news." 

Research from Hanley, Kwon and colleagues published in the peer-reviewed Journal of the American Medical Association last year found that opportunistic salpingectomy could help to reduce the number of ovarian cancer cases. 

Ovarian cancer is something that I see almost on a daily basis ... and any opportunity we have to prevent ovarian cancer is certainly worthwhile.- Janice Kwon

They found that the nearly 26,000 individuals who underwent opportunistic salpingectomy had significantly fewer serous and epithelial ovarian cancers than were expected, compared to the rate among the control group who had either only a hysterectomy or tubal ligation. 

When they looked at high-grade serous cancers in particular, there wasn't a single case found among those who had their fallopian tubes removed. 

"Ovarian cancer is something that I see almost on a daily basis. I've treated hundreds of women with that illness and any opportunity we have to prevent ovarian cancer is certainly worthwhile," Kwon said.