Should we still be talking about ‘ovarian’ cancer?

Last week an article entitled 'Why are we still talking about 'ovarian' cancer' was published and has since been widely shared on the internet.

Here our Cancer Prevention Officer, Jo, takes a look at the implications.

“Women at greater risk of ovarian cancer due to a genetic mutation have options to reduce their risk. But these are life-changing decisions and ones that need careful consideration.

For many years we have been aware that a significant proportion of high grade serous ovarian cancer originates in the fallopian tubes. The debate about what exactly that proportion is, and what this should mean for patients and women at high risk, is ongoing. This subject is of significance because knowing the origins of a cancer can feed into research and inform prevention and treatment strategies.

Research is constantly progressing and uncovering further information about the fallopian tubes that could impact treatment and detection in the future.

In 2016, results of Ovarian Cancer Action funded study showed that levels of a protein called SOX2 are much higher in the fallopian tubes of people with ovarian cancer. They are also higher in some people who are at high risk of developing ovarian cancer, such as those with inherited mutations in BRCA1 and BRCA2 genes.

These findings are significant and could, in time, lead to the development of an ovarian cancer screening tool.

So how does this translate into action for women with BRCA1/2 gene mutations? Unfortunately, although progress is being made, there is not yet the evidence to show that fallopian tube removal alone is enough to significantly lower the risk of ovarian cancer.

That said, in November 2014 a scientific impact paper from the Royal College of Obstetricians and Gynaecologists (RCOG) suggested that women at normal risk of ovarian cancer who are having abdominal surgery for another reason consider having their fallopian tubes removed as part of that operation. This echoes the advice from other countries such as the United States, Australia and New Zealand.

The general advice from RCOG, however, remains the same. If you have a genetic mutation that increases your risk of ovarian cancer, the most effective way to reduce this risk is to remove your ovaries and fallopian tubes. If you have a BRCA1 mutation, the suggested age for this is 35-40. If you have a BRCA2 mutation you should consider this surgery by the age of 45.

If you have completed your family, are not yet at the age where you wish to have your ovaries removed, but are planning to have an abdominal surgery or sterilisation, it may be worth speaking to your medical team about the options to remove your fallopian tubes at the same time. This should not be in place of removing your ovaries at a later date, but may offer you some risk reduction in the interim.

In the meantime, familiarise yourself with the symptoms of ovarian cancer. Know your body and keep a note of anything that feels different using our symptoms diary.

As a BRCA1 mutation carrier myself, and having lost my mum to ovarian cancer, I am always looking out for options to reduce my ovarian cancer risk. It’s exciting to know research is going on into different options apart from removing my ovaries, as the risks of going into premature menopause overnight are life-changing and not something I’m keen on rushing. However, we must remember that research takes time, and we are not in the position yet to say we can just remove our fallopian tubes and leave our ovaries. What we can do is ask our medical teams all the questions we can about how these findings apply to our own personal risk and health situations in relation to our life plans, and act accordingly.”

For further information about your hereditary risk of cancer, visit ovarian.org.uk/brca or email brca@ovarian.org.uk