It’s been known for almost 10 years that the term “ovarian cancer” is a misnomer. Almost all of these diseases begin somewhere other than the ovary – most usually in the fallopian tubes, meaning that ovarian cancer as a defined entity doesn’t really exist. So why aren’t most doctors, let alone our patients, aware of this?
When I first began studying this problem, my colleagues and I assumed the knowledge gap was between doctors and patients. But on further inspection, we realized that many doctors were also unaware of the true nature of “ovarian cancer.” Why? Because many of the discoveries about its true origins were made by pathologists. Once prophylactic removal of the tubes and ovaries became commonplace in people who carry the BRCA1 or BRCA2 mutations, pathologists (notably Robert Kurman of the Johns Hopkins University School of Medicine) were able to study the specimens and gain further insight. They found that all of the cancers, or pre-cancers, started in the fallopian tubes or other pelvic organs, but not in the ovaries.
The information was published and is available in the pathology literature, but most gynecologists and oncologists aren’t reading it. Our increasing specialization is compartmentalizing and fragmenting medical knowledge – and creating a barrier between the different specialties. It’s only by stepping back and looking at the bigger picture that we can spot some of the truly remarkable things that the general public (and sometimes the medical community at large) simply aren’t aware of. Even though the pelvic cancer discovery goes back to 2007, only since 2017 has the American Society for Gynecologic Oncology begun to acknowledge that a paradigm shift has occurred. But they’re still using the term “ovarian cancer”…
I believe the name change will happen, but it will occur gradually as medical practice changes. There’s so much history here; we’ve been calling these diseases “ovarian cancer” for generations. I think, in a way, it is hard for us to admit we were wrong about something so fundamental. But if we really want to be accurate in our diagnoses, and practice precision medicine, we need to start calling things what they really are – and let go of traditional terms that modern science has rendered inaccurate.
“Our increasing specialization is compartmentalizing and fragmenting medical knowledge – and creating a barrier between the specialties.”
Progress is being made: my colleagues and I are now using all of the tools at our disposal to bring about change. We communicate with the public via articles, television appearances, and Twitter, Facebook and other social media. We’ve also recently published a book: “Reimagining Women’s Cancers.” The word is now beginning to spread: to prevent ovarian cancer, some women may only have to have their fallopian tubes removed, leaving their ovaries intact and preventing premature menopause along with all of the associated comorbidities.
There are several small clinical trials now underway studying the comparative effects of removing the ovaries and fallopian tubes, versus just the tubes (1)(2)(3) – and to enhance enrolment, more doctors and patients need to know about them. Eventually, studies like these could lead to a completely new way of diagnosing and screening for “ovarian cancer” – one that is grounded more solidly in the latest science, resulting in better understanding of pelvic diseases, and better outcomes for patients.
It doesn’t stop there – by looking at the bigger picture and not confining ourselves to disciplinary boundaries, we will be able to make connections between different fields of medicine and glean information that isn’t yet taught in medical school – gaining insights that have the potential to transform medicine.
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- ClinicalTrials.gov, “Prophylactic salpingectomy with delayed oophorectomy”, (2017). Available at: bit.ly/2fZfKC0. Accessed October 10, 2017.
- ClinicalTrials.gov, “Salpingectomy at cesarean delivery for ovarian cancer reduction (SCORE)”, (2017). Available at: bit.ly/2yE7v9L. Accessed October 10, 2017.
- ClinicalTrials.gov, “Fallopian tube removal as a method of ovarian cancer prevention: a descriptive study”, (2017). Available at: bit.ly/2yd1TlF. Accessed October 10, 2017.