Among women with symptomatic ovarian cancer, BWH researchers determined that the fallopian tube was a starting point in 50 percent of cases.

Angelina Jolie Pitt’s decision to have her ovaries and fallopian tubes removed highlighted concerns about an uncommon but lethal disease – ovarian cancer. About one in every 70 women will get ovarian cancer in their lifetime, versus one in nine women who will develop breast cancer. Although ovarian cancer is less common, the odds of survival for women with the disease are much lower than for those with breast cancer. Of the 22,000 women who develop ovarian cancer each year, nearly two-thirds die from the disease.

Lower survival rates are partly due to the fact that ovarian cancer often is diagnosed much later than other cancers. Currently, there are no screening tests for early detection of ovarian cancer, and symptoms are non-specific and vague. Symptoms may include bloating, abnormal bleeding, or other abdominal symptoms. However, ongoing research at Brigham and Women’s Hospital (BWH) is shedding light on who is at risk for developing ovarian cancer and what steps can be taken to reduce that risk.

Ovarian Cancer Risk Factors

Women who are born with BRCA 1 and BRCA 2 gene mutations have a much greater risk of developing both breast and ovarian cancer in their lifetime. In women with these mutations, the risk for developing breast cancer may be as high as 80 percent and as high as 40 percent for ovarian cancer. As a result, if a woman is known to have a BRCA mutation, it is recommended that she consult her physician and genetic counselor about the advantages and disadvantages of having her ovaries and fallopian tubes removed by age 40, when the risk begins to accelerate. Removal of the ovaries and fallopian tubes will reduce the risk of developing ovarian cancer by about 90 percent.

Beyond genes, other factors may reduce the risk of ovarian cancer. These include having multiple births, the use of oral contraceptives, and breastfeeding. Women who have undergone tubal ligation also have a lower risk of developing ovarian cancer.

Link between Ovarian Cancer and the Fallopian Tubes

The recommendation to remove the fallopian tubes as well as ovaries in BRCA-positive women is based on research done at BWH. In 2005, a team of pathologists led by Dr. Christopher Crum, Division Chief of Women’s and Perinatal Pathology, developed a method called the SEE-FIM protocol for evaluating the end of the fallopian tube to detect the origin of ovarian cancer. Using the SEE-FIM protocol, BWH researchers evaluated the fallopian tubes of women who had BRCA mutations. They found that five to 10 percent of these women had a very early cancer in the fallopian tubes. Among women with symptomatic ovarian cancer, BWH researchers determined that the fallopian tube was a starting point in 50 percent of cases.

In this video, Dr. Crum discusses additional steps that can be taken to reduce ovarian cancer risk and research to develop diagnostic tests that can further identify ovarian cancer risk or detect early signs of the disease.

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– Jamie R.

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