The issue regarding ovarian cancer always but we never really understood the true biology of ovarian cancer. Probably in the last decade or so there has been a lot of work done showing that the most lethal form, if I may say, of high grade serous ovarian cancer actually originates from the distal end of the fallopian tube. This is, of course, a game changer because when we looked at ovarian cancer and had assumed that some advanced disease actually originated from the ovary we were looking at the wrong primary site. The implications of this are not only how do you prevent ovarian cancer occurring but it also has been revealed, for example within the screening trial in the US which has already reported showing no benefit to population screening for ovarian cancer, and this could be explained by the fact that if you are screening for abnormalities in the ovary but the origin is in the tube you're actually screening metastatic disease. It's sort of akin to screening the lymph nodes of the axilla to get a primary breast cancer.
So it is sort of a game changer in that sense and I would predict that in the future we'll see increasingly that we'll recognise these high grade serous, the most lethal type of tumour, probably the origin is the fallopian tube in many, many cases, rendering ovarian cancer an extremely rare disease. And that has challenges in itself: as this evolves, of course, if you want to introduce a screening programme, how are we going to screen the fallopian tubes, it's quite difficult. There is a pre-invasive element there but how do you access the fallopian tubes?
So there's quite a lot, if you like, happening at the moment which can be looked at as challenges and opportunities but it is a game changer. It doesn't change how we're going to manage our patients here and now but it just means that we've been looking at ovarian cancer presenting as an advanced disease not realising, yes, it was advanced but actually it's a fallopian tube cancer advancing. And doing some work involved in the epidemiological work in the UK we do see a massive increase in the diagnosis of primary fallopian tube cancers now as the pathologists look for the precancerous conditions in the fallopian tubes in pathology.
So it's interesting, it won't change our practice of care of patients but it does open a new door that is quite challenging, particularly for screening.