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.
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.
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.
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.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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