Vancouver – B.C. scientists published their research findings today in JAMA Network Open, that suggests removing a woman’s fallopian tubes at the time of other routine gynecologic surgeries is a safe, effective way to reduce ovarian cancer risk for women, ultimately leading to lives saved.

The procedure, called opportunistic salpingectomy (OS), takes advantage of an opportunity to remove the fallopian tubes when a person is already undergoing hysterectomy or instead of tubal ligation—often referred to as “having your tubes tied”—while leaving the ovaries intact.  

This ovarian cancer prevention strategy was developed and named by Dr. Dianne Miller, OVCARE co-founder, gynecologic oncologist at Vancouver Coastal Health’s Vancouver General Hospital and BC Cancer, and associate professor emerita at the University of British Columbia (UBC). This novel change in practice, led by B.C., has since been adopted and recommended by many professional gynecological societies around the world. 

Though it’s great to cure cancer or improve outcomes it’s even better to never get cancer in the first place and that’s what this ovarian cancer prevention strategy is all about.

Dr. Dianne Miller, Co-founder of OVCARE & Gynecologic Oncologist

In recent decades, scientists have discovered that most cases of the most common and lethal type of ovarian cancer – high-grade serious carcinomas (HGSCs) – arise in the fallopian tubes that transport eggs from the ovaries to the uterus. The new research reveals how removing the fallopian tubes with OS can help save lives by preventing HGSCs, which have a five-year survival rate of less than 50 per cent. Approximately 70 per cent of ovarian cancers and nearly all ovarian cancers in people with a BRCA mutation (Breast Cancer gene mutations) are HGSCs. 

For the study, senior author Dr. Gillian E. Hanley, Canada Research Chair in Population-Based Gynecologic and Perinatal Outcomes and assistant professor in UBC’s department of obstetrics and gynecology, examined observed verses expected rates of ovarian cancer among individuals who have undergone OS.

“The study found significantly smaller numbers of observed ovarian cancers compared with expected numbers for patients who underwent prophylactic OS at the time of hysterectomy or instead of tubal ligation,” said Hanley, research scientist at the Vancouver Coastal Health Research Institute. “There was not a single serous ovarian cancer in the OS group, which was significantly fewer than the slightly more than five that were expected.”

These findings strengthen the evidence for presenting OS as an option to individuals at average risk of ovarian cancer. The study further showed that the OS group had the same risk of breast and colorectal cancers compared with the control group, indicating that the reduction in ovarian cancer within the OS group is probably due to the removal of their fallopian tubes. 

As physicians who care for women with ovarian cancer, we would obviously prefer no women to be diagnosed with this deadly disease, to see proof that this cancer can be prevented by OS is thrilling.

Dr. Sarah Finlayson, Gynecologic Oncologist (Vancouver General Hospital & BC Cancer)

The average age of diagnosis of ovarian cancer is 61. Many of the study participants underwent OS in their 40s, and as these participants age, the researchers expect that the number of cancers prevented will grow to 37 women in 2022 and 45 by 2027. Many more people have since had OS who were not included in this study, increasing the impact of this intervention further. 

“My mom was 66 when she died of ovarian cancer, my grandmother died at the age of 52 of ovarian cancer. My mom didn’t have a BCRA gene, but the geneticist thought the odds were just too great so I was recommended to undergo OS,” said Justine Greene, a patient partner in ovarian cancer prevention. “I was 39 at the time when I had my tubes removed, I had a son, and I was done having children so OS seemed like a no-brainer. It just seemed like the family story of ovarian cancer in my family needed to stop and that’s why I did it.” 

Study Measures

• This research involved a population-based retrospective cohort study of all individuals in British Columbia who underwent OS or a control surgery (hysterectomy alone or tubal ligation) between 2008 and 2017, with follow-up until December 31, 2017. 
• All individuals who underwent a hysterectomy or tubal sterilization between 2008 and 2017 were included. 
• Those with any gynecological cancer diagnosed before or within six months of their procedure were excluded. 
• There were 25,889 individuals in the OS group, consisting of 14,066 who underwent hysterectomy with OS and 11,823 who underwent OS for sterilization. 
• There were 32,080 individuals in the control group, consisting of 10,446 individuals who underwent hysterectomy alone and 21,634 who underwent tubal ligation.

“This result is the culmination of ten years of team science and we look forward to working together to maximize the impact of this program and to further improve our prevention tools through better understanding the origins of all ovarian cancers.” said David Huntsman, scientific lead for OVCARE and professor at UBC.

This research was supported by funding from the Canadian Institutes of Health Research, Canadian Cancer Society, Michael Smith Health Research BC, VGH & UBC Hospital Foundation, and BC Cancer Foundation. 

Learn more:

• For more information about ovarian cancer, visit BC Cancer’s ovarian cancer webpage.
• To learn more about ovarian cancer at Vancouver Coastal Health, click here.
• To find out more about the OVCARE partnership, click here.  
• A video on opportunistic salpingectomy can be viewed here.

Organizations Involved

Ovarian Cancer Research Centre (OVCARE) is is British Columbia’s multi-institutional and multidisciplinary ovarian cancer research group. OVCARE was founded in 2000 and has grown from a small group of researchers and disconnected research projects to a coherent team that is recognized internationally as a leader in the study of ovarian cancer. OVCARE was developed as an initiative between BC Cancer, UBC and the Vancouver Coastal Health Research Institute, supported in part from philanthropic funding UBC Faculty of Medicine, BC Cancer Foundation and VGH & UBC Hospital Foundation. 

Vancouver Coastal Health (VCH) is responsible for the delivery of $4.1 billion in community, hospital and long-term care to more than one million people in communities including Richmond, Vancouver, the North Shore, Sunshine Coast, Sea to Sky corridor, Powell River, Bella Bella and Bella Coola. VCH also provides specialized care and services for people throughout B.C., and is the province’s hub of health-care education and research.

Vancouver Coastal Health Research Institute (VCHRI) is the research body of the Vancouver Coastal Health and a world leader in translational health research. VCHRI is academically affiliated with UBC Faculty of Medicine and includes three of BC’s largest academic and teaching health sciences centres—Vancouver General Hospital, UBC Hospital, and GF Strong Rehabilitation Centre—as well as other hospitals and public health agencies across Vancouver Coastal Health. As one of Canada’s top funded research institutes, VCHRI receives over $100 million in research funding annually to support health research and discoveries with direct health, economic and social impact on British Columbians.  

BC Cancer Foundation is the fundraising partner of BC Cancer and the largest charitable funder of cancer research in the province. The BC Cancer Foundation works with donors and communities to advance research and innovate care for the people of B.C. Together, BC CAN change the outcome for each person facing this disease. BC CAN break down cancer. 

VGH & UBC Hospital Foundation is Vancouver Coastal Health’s primary philanthropic partner and the engine for health care innovation and transformation in British Columbia. By recruiting world-class medical professionals and equipping them with the tools and technology to do their best work we are improving the health of our communities and saving lives across the province. 

Patients across BC with the most complex health care needs are referred to the Vancouver Coastal Health sites we support: VGH, UBC Hospital, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute and Vancouver Community Health Services. 

The UBC Faculty of Medicine is a leader in both the science and the practice of medicine, ranked among the world’s top medical schools with the fifth-largest MD enrollment in North America. Guided by our vision—to transform health for everyone—our faculty members, learners, staff and alumni are accelerating discovery and creating pathways to better health for communities at home and around the world. Through collaboration with our partners, we strive to meet the demands of today and tomorrow, bringing real and lasting hope to people everywhere. For more information, visit med.ubc.ca or follow us on Twitter @UBCmedicine.  

BC Cancer, a program of the Provincial Health Services Authority, is committed to reducing the incidence of cancer, reducing the mortality from cancer and improving the quality of life of those living with cancer. It provides a comprehensive cancer control program for the people of British Columbia by working with community partners to deliver a range of oncology services, including prevention, early detection, diagnosis and treatment, research, education, supportive care, rehabilitation and palliative care. For more information, visit www.bccancer.bc.ca or follow us on Twitter @BCCancer.

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This news release is based on an article by the Vancouver Coastal Health Research Institute.