Ovarian Cancer: A Shift in Understanding and a Personal Choice

Last week, Gina Kolata reported in The New York Times that ovarian cancer is largely a misnomer. The disease, which causes more deaths than any other gynecologic cancer in the US, often originates in the fallopian tubes, not the ovaries, and removing the fallopian tubes can reduce a woman’s risk by nearly 80%.

A Personal Journey with BRCA1

My sister shared the article with me, along with several friends, as it ran. I’d known this information for almost a year, having opted for a salpingectomy – the removal of my fallopian tubes – instead of ovarian removal after being diagnosed with the BRCA1 genetic mutation at 30.

Facing a Significant Risk

My mother also tested positive for the BRCA1 mutation, presenting me with a 50% chance of carrying it. The associated breast cancer risk (up to 87% over a lifetime) is widely known, but the lower, yet more frightening, ovarian cancer risk (around 40%) was what truly concerned me. Ovarian cancer is difficult to detect early, relying on advanced tests that often signal the disease only in its later stages.

Delaying Standard Treatment

I delayed having my ovaries removed due to potential side effects and a desire to avoid surgical menopause, particularly given a family history of dementia and other potential risks associated with early menopause. I was in my 30s and didn’t want to go through menopause yet. Doctors initially advised removing my ovaries by 40, but I fought to postpone the procedure.

New Research Highlights Fallopian Tubes

Recent research, highlighted by the New York Times article, suggests that most ovarian cancers originate in the fallopian tubes, not the ovaries. This understanding has evolved over time, with a Dutch doctoral student, Jurgen Piek, first proposing this theory in 2001.