VANCOUVER — There’s good news and there’s bad news when it comes to research on ovarian cancer.
The bad news is that this disease, dubbed the “silent killer,” is still the leading cause of cancer-related deaths among women, affecting one in 70, with a much larger concentration in women of Ashkenazi descent. The good news is that while the outlook is still bleak for screening and treatment, prevention is looking more promising.
Approximately 50 women gathered to hear this good news at Vancouver’s Jewish Community Centre recently, at a presentation delivered by gynecologic oncologist Dr. Sarah Finlayson and gynecologist Dr. Mark Rosengarten.
“I’ve seen too many of my patients lose a very courageous battle against ovarian cancer,” Rosengarten said. “In eastern Europe, we didn’t dilute our gene pool enough, which is why Ashkenazi Jews have a higher risk of these cancers.”
Rosengarten noted that the disease tends to spread fear and panic in the community, and that until now the only preventative treatment has been removal of the ovaries. “That’s not an easy thing to live with and often leaves women a shell of their former selves,” he said.
Finlayson, who works at Vancouver General Hospital and the BC Cancer Agency, said that until three years ago, researchers at the BCCA thought of ovarian cancer as one disease and used a single treatment approach. “Today we know there are five subtypes of the disease, and we have a screening test in development,” she said.
Each of those subtypes has different etiology, symptoms, treatment and prognosis, but the most common is high-grade serous cancer, also associated with the BRCA 1 and BRCA 2 gene mutations. Those gene mutations are found in one out of every 40 women of Ashkenazi descent.
“In the past, we were looking at the ovary to see where the cancer started, ignoring the fallopian tube,” Finlayson said. “When we began looking at the fallopian tube, we started getting some answers. We realized these aren’t ovarian cancers at all, they’re fallopian tube cancers, and learned that the fallopian tube is the culprit in the majority of these cancers.”
Finlayson and her team have begun a B.C.-wide educational initiative to take their research from the laboratory to the operating room. “We’re asking doctors to remove the fallopian tubes at the time of hysterectomy and tubal ligation,” she said.
Rosengarten added that it is reasonable for women with a family history of gynecological cancer, for those who are anxious and concerned about getting ovarian cancer, and for those who have tested positive for BRCA 1 or BRCA 2 to consider having their fallopian tubes removed by age 40, provided that they did not intend on having more children. By age 50, he said it is reasonable for women concerned about the disease to have their ovaries removed, too.
“This is important because we’re talking about prevention, not screening or treatment, which are still a sad story,” Finlayson stressed. “We really believe that by making these simple surgical changes, we could see up to 50 per cent reduction in ovarian cancer deaths in the next 20 years.”