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

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White Coat Black Art26:29Preventing ovarian cancer

 

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.

An illustration shows the ovaries and the removal of the fallopian tubes during an opportunistic salpingectomy. (Screenshot/Gynecologic Cancer Initiative)

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.

A woman with dark hair and light blazer stands in front of leafy, blurred background.
Dr. Janice Kwon, a gynecologic oncologist with Vancouver General Hospital and BC Cancer, says ovarian cancer is something that she sees almost on a daily basis. (Submitted by Janice Kwon)

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.

A woman with dark curly hair smiles at the camera.
University of British Columbia associate professor Gillian Hanley says opportunistic salpingectomies rates are increasing, but there’s ‘still definitely room for improvement.’ (Submitted by Gillian Hanley)

“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.

WATCH | Why specialists recommend doctors talk to patients about the surgery: [embedded content]


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.

Woman with dark red hair and red outfit smiles at the camera.
Donna Pepin, an ovarian cancer patient, says at this point there’s no way to prevent this disease aside from opportunistic salpingectomy. (Submitted by Donna Pepin)

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.

 

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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