"We are hoping to put ourselves out of a job"
The end of ovarian cancer is within our grasp, but first Drs. Kara Long & Becky Stone have to change the entire medical system & teach fellow physicians basic female anatomy. You know. No biggie.
Recently, on my morning walk, I stopped cold in my tracks. Did I just hear what I just heard? I was listening to a podcast produced by Memorial Sloan Kettering Hospital. One of those internal communication productions you have to want to find to find it, which I sometimes do whenever I’m searching for information about female bodies and women’s health that is either not being reported or being under-reported in the press.
I hit rewind: thirty seconds, then thirty seconds more. Holy shit! I did hear what I just heard. In my ears, Drs. Kara Long and Becky Stone, gynecologic surgeons and oncologists, were chatting about ovarian cancer. The most lethal form of ovarian cancer grows in the fallopian tubes, they were explaining, not the ovaries. Remove the fallopian tubes, and you remove the chance of dying from ovarian cancer.
Wait, what? It’s that simple? For a cancer that strikes 1 in 78 women and is nearly always fatal? For a cancer that, unlike breast or colon cancer, has no symptoms, no way of screening for it before it has spread everywhere in the body and is too late? What kind of sorcery was this, and why had I not heard of it?
I contacted Dr. Long. She introduced me to Dr. Stone. The three of us had a long chat over zoom, which you can watch below.
These two surgeons, friends since their days working together at Johns Hopkins, have been fighting an uphill battle, they told me, to get American patients and doctors alike to understand that this is a massive but necessary paradigm shift in how we think about cancer prevention.Instead of screening for the presence of an already extant cancer via mammogram or colonoscopy, the removal of the fallopian tubes—which, unlike the ovaries, serve no purpose in a post-menopausal body—would prophylactically remove the chance of getting ovarian cancer in the first place.
Great, right? An amazing discovery and an easy fix that has the potential to save thousands of lives every year. Opportunistic salpingectomyFTW! Let’s rebrand ovarian cancer as fallopian tube cancer, so people will understand the shift in thinking! Let’s get women of post-reproductive age to consider having their fallopian tubes removed when they undergo other pelvic procedures, like gall bladder removal or hysterectomy! Hooray for women’s health!
But wait. Not so fast. In an ideal world, yes, this would be great, but we live in a country hostile to the study of female bodies, ignorant of women’s health, and intent on keeping us from medical reimbursement at every turn. Which means Drs. Long and Stone have their work cut out for them and then some.
First, between caring for their patients with ovarian cancer; watching helplessly as they die; and comforting their widowers, parents, siblings, and kids, these two surgeons have to convince and educate all of the other surgeons in the U.S. who might ever open up a female pelvis—as well as every American with a uterus—to completely rethink preventive medicine. To wit, here are some questions (with answers) every doctor and woman should be asking themselves:
Are you a doctor conducting a hysterectomy or a patient who is getting a hysterectomy?
Remove the fallopian tubes along with the uterus.
Are you a surgeon opening up a post-reproductive female pelvis for another reason (appendectomy, gall bladder removal, etc.)?
Consider removing the fallopian tubes and discuss the reasons why with your patient prior to surgery.
Are you an American with a uterus who is still of reproductive age but considering getting your tubes tied because abortion is illegal in your state or you don’t want to have any more children?
Don’t tie them. Remove them.
Do you have a family history of ovarian cancer?
Consider prophylactic fallopian tube removal, even if you’re still of childbearing age. With IVF, you can still grow a baby inside your own uterus without fallopian tubes.
An even bigger challenge to this new framing of the ovarian cancer paradigm is this: Drs. Long and Stone have to convince American insurance companies to completely rethink cancer prevention. Opportunistic salpingectomy—removal of the fallopian tubes during any random pelvic procedure—has to have a proper insurance code, for starters, and to get reimbursed, at the very least. Then it has to be seen as the first line of ovarian cancer prevention in the same way mammograms and colonoscopies have become the first line of prevention for breast and colon cancers. Equally critical (if perhaps more difficult), they must educate their fellow surgeons about basic female anatomy in a world that only recently—we’re talking 2016!—produced a 3-D model of the clitoris and barely pours any money into the study of the female body.
You know. No biggie.
I joke, but this is serious and urgent. So serious, so urgent, and so in need of immediate dissemination to the general public, I actually pitched the story of these two surgeons to a major magazine back in January, to give it and Drs. Long and Stone as big an audience as possible. It was turned down, twice. (Reason #1 why I started this publication: to arm you with the kind of information about your bodies and the bodies of your loved ones that is often deemed unnecessary, too boring, or too female-centric to publish in publications run by men or that count on advertising, clicks, and eyeballs to pay the bills. And yes, please feel free to support my work with a paid subscription by clicking the button below so I can keep doing this. Once again, I’m making women’s health news free, as I see this as a personal mission, but missions take time and resources.)
This leaves you, gentle readers, to spread the word about this new ovarian cancer prevention protocol to your sisters, your mothers, your daughters, your grandmothers, and your female and trans man friends. Listen to my conversation with Drs. Long and Stone above. Educate yourselves on the latest preventative thinking. Share this story. Watch this excellent anatomical educational module produced by Dr. Stone at Johns Hopkins, which explains everything about prophylactic fallopian tube removal in simple detail. (I’ve taken the liberty of doing a screen recording of it and uploading it to YouTube for easier access below.)
If doubters as to the efficacy and importance of prophylactic/opportunistic salpingectomy need further proof, show them this report from the Ovarian Cancer Research Alliance, which on January 30, 2023 came out with a radical and important statement about ovarian cancer screening. In a nutshell? It doesn’t work! You cannot screen for ovarian cancer. Full stop. Instead, they suggest several courses of action, one of which is the following (bold letters my addition):
“Encouraging those who are undergoing pelvic surgeries for benign conditions (hysterectomy, tubal ligations, cysts, endometriosis) to consider having their fallopian tubes removed. As the fallopian tube is the origin of most high-grade serous cancers, fallopian tube removal has been shown to dramatically reduce risk for a later ovarian cancer diagnosis.”
So. What does this mean for the average person born with a uterus? Take me, for example. I do not have a history of ovarian cancer in my family, nor do I have the BRCA gene. But! I do have a father who died relatively young from pancreatic cancer, which puts me in a general risk basket. Since 2006, my pelvis has been operated on by surgeons four times during four different surgeries: appendectomy, hysterectomy, trachelectomy, and emergency surgery to repair a vaginal cuff dehiscence. Not once, prior to any of those surgeries—even with my family history of pancreatic cancer—was it ever suggested to me that I should have my fallopian tubes prophylactically removed to prevent ovarian cancer. And yet this has been the standard of care in British Columbia, for example, for fifteen years now and counting.
Yes, I’m pissed about this, and yes, this is exactly what must change going forward. Power, Drs. Stone and Long argue, must revert back to the patients. But power requires information. To this end, patients and doctors alike must be armed with the following facts before going into any pelvic surgery or when considering a family history of ovarian cancer:
In a post reproductive female body, the ovaries continue to supply hormones that influence the sex drive as well as protecting their host from heart attacks and thinning bones, so their removal should be considered one of the last lines of defense. Fallopian tubes, on the other hand, have no post-reproductive purpose whatsoever other than to play potential host to a lethal cancer that then spreads to the ovaries. If you are past reproductive age and having pelvic surgery of any kind, consider having them yanked out.
Ovarian cancer most often starts as fallopian tube cancer. Remember this. Think of it as fallopian tube cancer, as some doctors are now suggesting. It helps to reframe it.
In a person of reproductive age with a high risk of ovarian cancer who still wants to have a baby, the fallopian tubes can be prophylactically removed, and then that person can still grow a fetus inside their own uterus via IVF.
Those with a uterus who knows they do not want to have children or who worry about not having access to legal abortion, should they get pregnant, and are therefore seeking to get their tubes tied—voluntary sterilization is on the rise, what with Roe v. Wade having been struck down—can and should easily and safely have their fallopian tubes removed instead of tied.
The most lethal form of ovarian cancer, high-grade serous cancer, grows in the fallopian tubes, not the ovaries, and it accounts for 70% of all ovarian cancers. Therefore the prophylactic removal of the fallopian tubes must be the first line of defense in ovarian cancer prevention.
Over one million women in America either have a hysterectomy or seek surgical sterilization or surgical contraception in the form of tubal ligation every year. That’s one million pre-surgical opportunities for doctors to educate patients about prevention of ovarian cancer in the same way they now urge their patients to get mammograms and colonoscopies.
“We spend long long days—you know 16-18 hour surgeries—,” said Dr. Stone, “treating patients with chemotherapy, being there with their daughters their husbands, their partners at the end of life. That is the gamut of what our every day is. The fact that we could significantly reduce the risk of what is a lethal cancer for 1 in 78 women, with a simple procedure that can be combined with another procedure? It's the holy grail. We have never had such an advantage over cancer maybe— arguably—in the history of medicine.”
Dr. Long agrees. “Becky and I like to say that our whole goal is to put ourselves completely out of our job taking care of people with ovarian cancer.”
Still, their climb remains steep. We cannot take advantage of this holy grail, put Kara and Becky out of work, or keep millions of kids from being orphaned or spouses from being widowed until every person with a uterus is aware of their options; until every surgeon with a scalpel and a specialty located in the female pelvic area knows where to find the fallopian tubes, at a bare minimum, let alone how to safely snip them; and until every insurance company in America realizes they can actually save money, in the long run, preventing an ovarian cancer from forming in the fallopian tubes in the first place, via opportunistic salpingectomy, instead of shelling out hundreds of millions of dollars for stopgap chemotherapies and surgeries that will, inevitably, fail.
A little while later, both the New York Times and the Washington Post would report these findings.
The removal of the fallopian tubes, also called an opportunistic salpingectomy, has been standard of care for the past 15 years in British Columbia.
The medical name for fallopian tube removal
THANK YOU for this! As a retired oncology nurse, it has frustrated me to no end that so many women are not believed when describing their ‘vague’ abdominal symptoms to MDs and then have it turn out to be (inevitably fatal) ovarian cancer. When I had my own hysterectomy at 45, for irregular bleeding, I told my surgeon to take my ovaries too, and then dealt with abrupt-onset menopause, and then weight gain, poor sleep and osteopenia since. Wish I’d known this 23 years ago! Sharing widely!
Wow. Bless Drs Long and Stone for fighting the good fight. Since I don’t live in the US, I don’t have these ridiculous insurance discussions-- but you bet I’m going to talk to my gynecologist about this radically simple approach at my next appointment. Spread the word!