OCRA encourages fallopian tube removal for women undergoing pelvic surgeries for benign conditions.

Abstract

Acknowledging the lack of an effective screening modality for ovarian cancer, the Ovarian Cancer Research Alliance (OCRA) recommends that women undergoing pelvic surgeries for benign conditions such as hysterectomy, cysts, tubal ligations, and endometriosis consider having their fallopian tubes removed. In a consensus statement1 issued on January 30, 2023, the organization cited the United Kingdom Collaborative Trial of Ovarian Cancer Screening, which found that general population screening did not significantly reduce ovarian and tubal cancer deaths.2 Not only did screening average-risk women with cancer antigen 125 and ultrasound not reduce ovarian cancer mortality, the results also showed that identifying stage I or stage II cancers did not affect mortality in many women. Elise C. Kohn, MD, head of gynecologic cancer therapeutics in the Cancer Therapy Evaluation Program at the National Cancer Institute, qualifies the OCRA statement, adding, “The cells of origin in most, if not all, high-grade serous ovarian cancer are in the distal end of the fallopian tube, or fimbria.” The Society of Gynecologic Oncology also endorsed OCRA’s recommendation. Still, Dr Kohn notes that there are limited data on the value of removing tubes in women who are not at high risk for ovarian cancer. “Because we have no good screening modality for ovarian cancer, we need to research other ways of reducing risk,” she says. “We’re trying to parse out recommendations for the general population and for highrisk women.” The previous standard of care for women at high risk for the disease based on BRCA1 and BRCA2 mutations was to remove the uterus, tubes, and ovaries; this reduced their risk of ovarian cancer by approximately 95%, notes Dr Kohn. More recently, clinicians began removing only the tubes and ovaries in these patients, and now they are postponing ovary removal until women are past their child-bearing years. The main questions that researchers still need to address for the general population are whether it is safe to remove fallopian tubes and whether doing so reduces the lifetime risk of ovarian cancer. Preliminary results from a 2014 British Columbia study have shown that it is both safe and feasible,3 although long-term data are needed for delaying ovary removal in high-risk women, Dr Kohn notes. She adds that none of the results in this area have been randomized and that a number of registry studies are underway. Dr Kohn notes that two prospective clinical trials are assessing the risk-reducing effects of fallopian tube removal: A Study to Compare Two Surgical Procedures in Individuals With BRCA1 Mutations to Assess Reduced Risk of Ovarian Cancer (NCT04251052 at ClinicalTrials.gov) and Risk Reducing Salpingectomy With Delayed Oophorectomy as an Alternative to Risk-Reducing Salpingo-Oophorectomy in High Risk-Women to Assess the Safety of Prevention—US Cohort Study (NCT05287451 at ClinicalTrials.gov). Encouraging patients to know their risk and the symptoms of ovarian cancer. Promoting genetic testing to at-risk populations. Encouraging those undergoing pelvic surgeries for benign conditions to consider having their fallopian tubes removed. Educating women or those born with ovaries about the symptoms of ovarian cancer. Educating patients to ensure that every person diagnosed with ovarian cancer is seen by a gynecologic oncologist and has access to the best standard of care. Encouraging cascade testing for patients’ family members when a genetic risk mutation is discovered. Promoting consideration of participation in clinical trials.