Gynecologic oncologists with the Ovarian Cancer Research Program at Vancouver General Hospital (VGH) and the BC Cancer Agency have begun an important campaign that will reduce deaths from ovarian cancer.
They are asking all BC gynecologists to change surgical practice to fully remove the fallopian tube when performing hysterectomy or tubal ligation. Current practice leaves the fallopian tube in place for many types of hysterectomy and tubal ligation. This is a matter of convention, not need.
The request stems from new research by the Ovarian Cancer Research Program at VGH and BC Cancer Agency. The BC research team and others have recently discovered that the majority of high grade serous tumours, the most deadly form of ovarian cancer, actually arise in the fallopian tube, not the ovary. The British Columbia data was published in 2009 in the International Journal of Gynecological Cancer.
The importance of the discovery was furthered by information contained in the Cheryl Brown Ovarian Cancer Outcome Unit, at VGH and BC Cancer Agency. The data demonstrated that 18 percent of women who had developed ovarian cancer had a prior hysterectomy.
"This was a eureka moment for us," says Dr. Dianne Miller, gynecologic oncologist with the Ovarian Cancer Research Program; chair, Gynecology Tumour Group, BC Cancer Agency; and associate professor, University of British Columbia, Faculty of Medicine. "This told us we can have an immediate impact on saving lives by removing the fallopian tube during these routine surgeries."
The research team, which is made up of surgeons, oncologists, and pathologists also made another important related discovery. They found one in five serous cancer tumours occur because of a germline BRCA genetic mutation.
"What this means is that in 20 per cent of cases, we are discovering the index case," says Dr. Blake Gilks, pathologist, Ovarian Cancer Research Program, and professor, Pathology and Laboratory Medicine, University of British Columbia. "A woman may have no prior history of ovarian cancer in her family, but we now know that her children and their children could be at risk, and we have the ability to screen them genetically and act proactively."
The research team is translating their findings to benefit patient care. With a donation from a private donor to VGH & UBC Hospital Foundation, they developed and produced an educational DVD, which has been delivered to all gynecologists within BC. The message is two-fold: remove the fallopian tube during surgery, and refer ovarian cancer patients who have a serous tumour to the Hereditary Cancer Program at the BC Cancer Agency.
The education outreach program is led by Dr. Sarah Finlayson, gynecologic oncologist, Ovarian Cancer Research Program, and asst. professor, University of British Columbia Faculty of Medicine.
"A vital component of health research is the uptake of the findings. We hope that by reaching out to both the clinicians and the public, we will be able to translate our work into important changes in patient care," says Finlayson. "We estimate these measures can reduce deaths from high grade serous cancer, the most lethal of all ovarian tumours, by 30 per cent through fallopian tube removal at hysterectomy and tubal ligation and an additional 20 per cent through proactively following families who have the BRCA gene mutation."
In Canada, Ovarian cancer affects 1 in 70 women and there are approximately 2500 new cases annually. High grade serous carcinoma is the most common form of ovarian cancer, accounting for 70 per cent of diagnosis and 90 per cent of advanced stage ovarian cancer.
"After decades of making very little progress in the prevention and treatment of ovarian cancer, it is thrilling to have this breakthrough," says Virginia Greene, president and CEO of the Business Council of British Columbia and ovarian cancer patient. "This discovery and the initiative put forward by the Ovarian Cancer Research Program of BC will positively impact the lives of many women in our province and beyond, and help prevent this deadly disease."
"British Columbians should be extremely proud of our province's leadership in the area of health research," says Kevin Falcon, B.C. Minister of Health Services. "This is a 100 per cent B.C. led initiative that will have a significant positive impact on the health of woman across our province, the country, and globally as well."
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