Ovarian Cancer Prevention: Within Reach but Unevenly Accessible
Authors: Emily Thorlakson, BSN RN (Vancouver Coastal Health) Alexandra Lukey, PhD(c), MSN, RN (University of British Columbia, Department of Obstetrics and Gynecology) | Editors: Romina Garcia de leon, Janielle Richards (Blog Co-Coordinators)
Published: October 4, 2024
The current state of ovarian cancer
Ovarian cancer is ranked number five in the leading causes of cancer deaths among females. Screening is a key pillar in cancer prevention, but unfortunately, there are no effective screening options for ovarian cancer. This leads to the majority of cases being diagnosed at late stages which reduces the chance of surviving ovarian cancer. Interestingly, science has shown over the last twenty years that most ovarian cancers start on the fallopian tubes and later spread to the ovaries instead of starting on the ovaries as researchers initially thought. This recent understanding has led to a new primary prevention opportunity called “opportunistic salpingectomy.”
Can Ovarian Cancer Be Prevented?
Opportunistic salpingectomy involves removing both fallopian tubes while leaving the ovaries intact; this procedure is typically completed during another scheduled surgery. Salpingectomy has gained traction as the latest research has proven that removing the fallopian tubes significantly decreases the risk of getting the most common and deadly type of ovarian cancer, called high-grade serous ovarian cancer. The most promising evidence of this comes from a population-based cohort study of people who received opportunistic salpingectomy for cancer prevention. This study found that individuals who had this particular surgery had no cases of serous ovarian cancer and significantly fewer than expected cases of other types of ovarian cancer. Also, researchers looked at the rates of different types of cancers that we would not expect salpingectomy to impact, and the study found that rates of other cancers, such as breast and colorectal cancers, were within the expected range. Therefore, these results increased the confidence that it was salpingectomy and not other confounding factors causing the lower ovarian cancer rates.
Is Salpingectomy Accessible to Everyone?
As salpingectomy becomes a more common procedure, we must ensure that everyone has equal access to it. Studies have already shown that geographical location, race, ethnicity, and rurality influence whether or not patients are offered opportunistic salpingectomy. For example, people who live in rural locations have less opportunity to be offered an opportunistic salpingectomy. Lack of equity is evident in research, as a study discovered that Black females were nearly half as likely to receive opportunistic salpingectomy in contrast to tubal ligation when sterilization was being done at the same time as a caesarian section. So, while they received permanent contraception, they did not receive the full preventative benefit of salpingectomy. Barriers to salpingectomy are compounded further by healthcare provider bias, lack of insurance coverage, low awareness or lack of healthcare resources.
Equity regarding salpingectomy is further complicated by the history of injustices and reproductive violence, such as forced and coerced sterilization of immigrants, Black, Latina, and Indigenous people; people with disabilities; and people with chronic medical conditions. For opportunistic salpingectomy to be available and equitably accessible to everyone, we must face the root of the problem by getting researchers, clinicians, and policymakers to address historical injustices while maintaining patient autonomy.
How Can We Make Opportunistic Salpingectomy More Accessible?
- Understand Barriers in Rural Areas: Identify and address challenges in rural and remote areas to patients who want opportunistic salpingectomy.
- Partner with Indigenous Communities: Collaborate with Indigenous leaders to have culturally safe discussions about ovarian cancer prevention.
- Knowledge Mobilization: Provide education and bias training for healthcare providers to ensure they offer this option fairly to all patients.