A new surgical approach that removes the fallopian tubes while sparing the ovaries may provide pre-menopausal women at high risk for ovarian cancer, particularly those with BRCA1/2 mutations, with a cancer risk–minimising surgical option that also reduces some negative effects of ovary removal at a young age, according to a review published in the May issue of Cancer Prevention Research, a journal of the American Association for Cancer Research.

Recent clinical evidence suggests that premalignant cells associated with ovarian cancer may, in fact, arise in the fallopian tubes and not the ovaries.

Therefore, it may be possible to reduce ovarian cancer risk and mortality among women at high risk through the removal of just the fallopian tubes.

“Angelina Jolie’s recent announcement about undergoing preventive removal of her ovaries and fallopian tubes has really put this issue into the national media and has made it easier to talk about this once taboo topic,” said lead study author Mary B Daly, MD, of the department of clinical genetics at Fox Chase Cancer Center. “With this discovery, we have made a real breakthrough in the understanding of ovarian cancer risk, but it is still too early for this surgical option to become standard practice.”

Ovarian cancer is relatively rare in the United States.

However, when diagnosed in late stages, it has a five-year survival of only 43.8%, and early screening methods are limited.

Among women with familial risk for ovarian cancer due to mutations in the BRCA1/2 genes, prophylactic removal of the ovaries and fallopian tubes—a bilateral salpingo-ooporectomy—has become the standard of care for risk reduction.

“For years, it was common thinking that ovarian cancer arose out of the single layer of cells that surrounds the outside of the ovary—the ovarian surface epithelium,” Dr Daly said.

“The problem with this theory was that researchers could never find premalignant lesions in these cells the way they could with most other solid tumours.”

In their review, Dr Daly and colleagues discussed the discovery that 10% to 15% of the fallopian tubes in women with BRCA1/2 mutations who underwent preventive bilateral salpingo-ooporectomy had premalignant or invasive cancer cells.

Subsequent studies showed that as much as 60% of women with sporadic ovarian cancer also had premalignant cells in their fallopian tubes.

“Removal of the ovaries and fallopian tubes in women any time before menopause puts women into immediate surgical menopause and results in short-term side effects including night sweats, hot flashes, and mood swings, and long-term side effects including an increased risk for heart and bone disease,” Dr Daly said.

“By undergoing fallopian tube removal alone, women would still have functioning ovaries and may not lose the protection that female hormones provide the heart and bones, but they may risk the possibility that ovarian cancer could still arise out of the ovaries.”

Dr Daly and colleagues also discussed this approach in the approximately 600,000 women at average risk for ovarian cancer who undergo hysterectomies each year in the United States.

Although these women are undergoing a procedure for a benign gynaecologic condition, preventive removal of the fallopian tubes may be another compelling opportunity for ovarian cancer prevention.

“We suggest the initiation of a national cohort study where women would not be randomised to one procedure or another, but instead would be entered into a national registry so that over time we could answer some of the questions about this procedure,” Dr Daly said.

Source: AACR