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Where Does the Research Money Go?

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UPDATE: CBC has recently put out an article directly related to this Post from Kevin Murphy:

https://www.cbc.ca/radio/whitecoat/ovarian-cancer-surgery-1.6876190

I have wanted for some years now to write a summary report describing the research that our donations contribute to and what outcomes have been generated from that research. It is easy to ask for donations for cancer research because most people are happy to give for a worthy cause. The term 'cancer research', however, represents a very complicated process by which answers to the intricate questions regarding cancer and its treatment can be brought to light. By describing the results of some of the research R2S has funded, I hope to help our team understand what remarkable progress we have supported.

What follows is the first installment of a series of blogs describing the outcomes of research that Ride 2 Survive has supported.

The Canadian Cancer Society sponsors a wide variety of research some of which involves trying to sort out how various molecules at the cellular level work to enhance cancer growth or inhibit it. Much of this has uncovered the genetic control over specific proteins and how they function within cancer cells or within its environment. Other forms of research include studying how cancers respond to treatment and how treatment resistance evolves within cancer cells. More recently, the Cancer Society has supported research studying outcomes of treatment at the population level. In other words, what happens when a treatment protocol is applied uniformly throughout a population of people suffering from a certain cancer or if the protocol is used to prevent certain cancers from developing?

The Use of Opportunistic Salpingectomy (Fallopian Tube Removal) to Prevent Ovarian Cancer

Ovarian cancer has been one of the hard-to-treat cancers as it is often found at an advanced degree of spread. Developing effective screening protocols for the general population has been a struggle. Trying to prevent ovarian cancer has been even more difficult. By focusing on populations at higher risk screening and prevention can provide better results. For some time, it has been known that women who carry a specific mutation (BRCA1/2) are at higher risk of developing breast and ovarian cancers. While the risk of an average woman in the general population developing ovarian cancer is about 1-2%, those with a BRCA1/2 mutation are at considerably higher risk. In those women, it is recommended to remove both the ovaries and fallopian tubes. This provides an 80% reduction in the risk of ovarian cancer. The problem with removing ovaries in the general population is the risk of significant side effects including coronary heart disease, osteoporosis, and higher risk of death. Since 80% of aggressive ovarian cancers arise in the general population, another method of prevention is needed.

Research conducted at many cancer research centers, including BC Cancer, have shown that most ovarian cancers originate from the fallopian tubes rather than the ovaries themselves.

That information has led to the use of 'opportunistic salpingectomy' at a time when women are undergoing a planned gynecologic procedure such as a hysterectomy. This involves removing the whole of the fallopian tubes and leaving the ovaries. This technique avoids the consequences of a premature menopause.

In 2010, the BC Cancer Gynecologic Tumor Group in association with gynecologic surgeons throughout the province proposed a protocol where women who were scheduled for a hysterectomy for a benign condition or tubal ligation (having the tubes tied) would instead have their fallopian tubes removed. From 2014 through to 2017, Ride 2 Survive contributed $225,000 for researchers, led by Dr. Gillian Hanley to perform a population-based study comparing the number of ovarian cancers occurring in a group of women who underwent opportunistic salpingectomy versus women who underwent a hysterectomy alone or a tubal ligation.

For those who wish to review the study in its details the reference is here:

DOI: 10.1001/jamanetworkopen.2021.47343

The population studied included 25,889 women undergoing an opportunistic salpingectomy and 32,080 who were the control group undergoing hysterectomy alone or tubal ligation. The two groups were fairly matched for important factors that contribute to the development of ovarian cancers.

In the control group, after approximately 7 years of follow up there were 36 patients with ovarian cancers and in the opportunistic salpingectomy group, there 5 or less ovarian cancers after 3 years of follow up. Colorectal and breast cancers were evenly distributed between the two groups, suggesting that the differences seen were not due to a selection bias.

The results of the study demonstrate the impact of a relatively simple surgical procedure in the prevention of a hard-to-treat cancer. Imagine how many ovarian cancers will be prevented once this protocol is adopted across the world.

When we ask for donations to the Canadian Cancer Society, we can point to this study as an example of what we can accomplish as members of the Ride 2 Survive.

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Wednesday, 19 June 2024