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SUNDAY SCIENCE: MOST ‘OVARIAN CANCER’ ISN’T. AND THAT FACT CAN
SAVE LIVES.  
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Gina Kolata
July 28, 2026
The New York Times
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_ The vast majority of cases begin in the fallopian tubes — and
removing them can reduce the risk by nearly 80 percent. _

Kira Wynn lost her mother to ovarian cancer, whose disease was
already at an advanced stage when she was diagnosed., KT Kanazawich
for The New York Times

 

Kira Wynn will do almost anything to avoid ovarian cancer, which
killed her mother.

“My mom thought she’d pulled a muscle in her side,” Ms. Wynn
said. Her mother’s doctor, she added, “told her to do physical
therapy.”

As is often the case with ovarian cancer, Ms. Wynn’s mother’s
disease was already at an advanced stage when she was diagnosed. She
died 10 months later.

Genetic tests could not pinpoint a mutation that would reveal whether
Ms. Wynn was at risk for ovarian cancer, too.

So Ms. Wynn, 37, had a consultation with Dr. Rebecca Stone, a
gynecological oncologist at Johns Hopkins Medicine. What she heard was
not what she expected.

“Ovarian cancer,” Dr. Stone told her, is a misnomer. Nearly all
ovarian cancers — and nearly all fatal ovarian cancers — are
actually cancers of the fallopian tubes. The 20 percent or so that
start in the ovaries are different, Dr. Stone said, and usually can be
cured.

Women who have their tubes — the gummy worm-shaped ducts that carry
eggs from the ovaries to the uterus — removed reduce their chances
of getting ovarian cancer by nearly 80 percent
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It’s a five-minute operation that can be done as part of nearly any
abdominal surgery, including a hysterectomy, tubal ligation,
gallbladder surgery and hernia repair.

Yet no doctor, Ms. Wynn said, had ever mentioned fallopian tube
removal to her.

That’s not surprising, Dr. Stone said, because most doctors (and the
public) do not know about this new approach, even though professional
groups like the American Cancer Society
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College of Surgeons
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and the European Society of Gynaecological Oncology
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recently issued statements encouraging doctors to offer tube removal
at the time of other abdominal surgeries.

Dr. Rebecca Stone, a gynecological oncologist at Johns Hopkins.
“Ovarian cancer,” she told Ms. Wynn, is a misnomer. Credit...KT
Kanazawich for The New York Times

The American Cancer Society is now working on a national campaign to
make more women and doctors aware that tube removal can help prevent
most ovarian cancers. The group plans to begin the campaign next year,
said Anne Reynolds-Doerr, a spokeswoman.

 

 

Women have, on average, a 1.1 percent risk
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with ovarian cancer, among the most deadly of all cancers. Screening
to find it early does not work
[[link removed](21)00731-5/fulltext]
(death rates do not budge). Ultrasound, blood tests and advanced
imaging have all failed. And most of the 20,000 women a year who
receive a diagnosis of ovarian cancer have no known risk factors. By
the time they find out why they have vague symptoms like bloating and
abdominal pain, the cancer has spread throughout their bodies. Surgery
and chemotherapy — the standard treatments — are unlikely to cure
them.

The tumors start as microscopic specks of cancer cells that spill out
of the wide end of the fallopian tube that is nestled against an
ovary. They seed the ovary and abdomen, where they grow and become
lethal.

Dr. Kara Long, an ovarian cancer specialist at Memorial Sloan
Kettering Cancer Center, likens these tiny cancer cells to dust coming
up from a rug and floating through a room.

Dr. Stone says they’re like dandruff drifting down to a person’s
shoulders.

That discovery, Dr. Long said, “was a lightbulb moment for us.” It
explained why early diagnosis so often failed: Those tiny cells do not
show up on ultrasound or other imaging.

But the finding did not seem to penetrate the medical community.
“How do you take a critical discovery, one of the most critical
discoveries in my lifetime, and move it to standard of care?” Dr.
Stone asked.

A colorized scanning electron micrograph of the fimbriae of a
fallopian tube, which help guide newly-released eggs into the tube.
Credit...Susumu Nishinaga/Science Source

The first inkling that most ovarian cancer starts in the fallopian
tubes began in 2000 with a Dutch Ph.D. student, Jurgen Piek. He knew
that women with certain mutations in either of two genes, BRCA1 or
BRCA2, had a greatly increased risk of ovarian cancer. Many decide to
have their ovaries removed preventively to protect themselves.

So Dr. Piek began studying the ovaries that the women chose to have
removed, looking for early signs of cancer. Doctors who remove ovaries
also remove fallopian tubes at the same time, because although ovaries
can survive without the tubes, the tubes cannot survive without
ovaries, which they rely on for their blood supply.

Dr. Piek noticed something that surprised him: He didn’t see any
precancerous cells in the ovaries, but he often found them in the
tubes. The cells looked just like early stage ovarian cancer.

In 2001 he postulated that ovarian cancer starts in the fallopian
tubes. “I was at a few conferences at the time as a Ph.D.
student,” Dr. Piek said. Most attendees, he recalled, said “he’s
a lunatic.” Others, he added, were intrigued.

Years of work followed.

“It took a lot of science for us to feel really confident about
recommending that people remove a structure,” Dr. Long said. There
were critical questions: Were the tubes the source of cancer in women
who had average risk? (The answer is yes.) Is it safe to remove tubes?
(Yes.) Does the operation damage the ovaries? (No.)

Dr. Kara Long, an ovarian cancer specialist at Memorial Sloan
Kettering Cancer Center. Credit...Heather Khalifa for The New York
Times

Dr. Joseph Sakran, a surgeon at Johns Hopkins Medicine, cautioned,
though, that published articles were not enough to change practice.
“There is a gap that exists between having the data out there and
having it implemented,” he said.

Because removing the fallopian tubes affects fertility, doctors take
care to explain the implications before offering the procedure. They
want to tread carefully, making sure women don’t think they are
being pushed into sterilization. There’s a long history of forced
sterilization of disabled people
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Black people [[link removed]] and
disadvantaged people.

Now, Break Through Cancer, a foundation in Cambridge, Mass., and the
American Cancer Society are conducting a study at Memorial Sloan
Kettering, MD Anderson Cancer Center and Johns Hopkins. Every woman
scheduled for abdominal surgery is offered a chance to see a video
explaining what is known about ovarian cancer, and is then asked if
she’d like her tubes removed during her surgery. Any woman can
decline to watch the video or decline to have her fallopian tubes
removed, for instance if she is considering getting pregnant some day
or just feels uncomfortable with the idea of having a healthy body
part removed.

Rolester Garner, 79, who lives in Baltimore, saw the video recently
when she came to Johns Hopkins for a preoperative visit before having
a hernia repair. She has no family history of ovarian cancer, she
said, and no known genetic risk. And she had no idea that most ovarian
cancer starts in the fallopian tubes.

But after finding out, she said, “I was going to go ahead with
it.” Dr. Sakran removed her tubes on July 13.

Rolester Garner has no family history of ovarian cancer, she said, and
no known genetic risk. But after finding out that most ovarian cancer
starts in the fallopian tubes, she had hers removed. Credit...KT
Kanazawich for The New York Times

Dr. Long said she and Dr. Stone looked back over the medical records
of their ovarian cancer patients to see how many had had abdominal
surgery sometime in the past. If they had been given the opportunity,
they could have had their tubes removed, preventing their cancers.

“Over a quarter had a missed opportunity,” Dr. Long said. “Oh my
gosh, it’s hundreds of patients.”

Kristin Buser, 42, who lives near Annapolis, Md., is one of them. She
was training for a 10-kilometer race last year when her symptoms
started. “Something was off,” she said. “I had irritable bowel
issues.”

Her doctor had thought Ms. Buser had irritable bowel syndrome but sent
her for a CT scan “to rule out anything weird,” Ms. Buser said.

She received a diagnosis on May 15 of last year: advanced ovarian
cancer. Treatment so far has involved five surgeries, nine rounds of
chemotherapy and five rounds of immunotherapy.

Pathologists discovered that her cancer had started in her left
fallopian tube. She had had a cesarean 10 years ago, along with a
tubal ligation, which cut the tubes but did not take them out. “They
had me wide open,” Ms. Buser said. It would have been so easy to
remove her tubes.

But, she said, “I refuse to look at this from the point of view of
poor, poor, pitiful me.” Instead, she added, she wants to tell her
story to help others so they don’t miss an opportunity to prevent
ovarian cancer.

“My biggest thing in life,” Ms. Buser said, “is to move forward
and stay positive.”

_GINA KOLATA_ [[link removed]]_ reports on
diseases and treatments, how treatments are discovered and tested, and
how they affect people._

_Subscribe to the NEW YORK TIMES_ [[link removed]]

HOW BLACK HOLES GET HITCHED
[[link removed]]ADRIAN
CHOSCIENCEAnalyses of hundreds of collisions find black holes pair up
in at least three waysJuly 30, 2026 

* Science
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* Medicine
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* cancer
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* ovaries
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* fallopian tubes
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* surgery
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