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Spreading the word to save lives

August 19 , 2011

When researchers make a significant new finding, the news is typically shared through publication in a journal. Maybe they will get to make a presentation at a conference. Depending on its news value, and what else is happening in the world that day, the discovery might be covered by newspapers, radio and television.

When BC’s Ovarian Cancer Research Program, OvCaRe, realized they had new knowledge to share, they weren’t content to let the word get out through those usual channels. It was just too important.

Their discovery — that at least two-thirds of high-grade serous tumours in the ovaries have actually originated in the fallopian tubes — had huge implications. It meant that removing the fallopian tubes, either in women who carry a genetic predisposition to such cancer or in women already undergoing a hysterectomy or tubal ligation, could reduce the incidence of such cancers by as much as 50 per cent.

The potential for lives saved impelled OvCaRe to launch a campaign to promote routine removal of the fallopian tubes when performing hysterectomies or tubal ligations.

“This seems simple and obvious but the concept evaded all of us until recently,” says Sarah Finlayson, an Assistant Professor in the Department of Obstetrics and Gynaecology and a gynecologic oncologist at OvCaRe at Vancouver General Hospital.

Changing ingrained practices is a slow process, even if the change is backed by peer-reviewed articles in respected journals. Previous articles detailing the fallopian tube revelation, which appeared months before OvCaRe’s independent findings, were pathology-oriented and didn’t explicitly delve into the clinical implications. Even OvCaRe’s article, published in 2009 in the International Journal of Gynecological Cancer, would not typically be read by the OB-GYNs who are best positioned to act on it.

Taking advantage of their role as the sole ovarian cancer group for the province, and their ability to communicate directly with most of the province’s gynecologists, they produced an educational DVD that was sent to all of BC’s 250 obstetrician-gynecologists (and posted on the OvCaRe website at ovcare.ca/news_practice%20changes.php). They also made it a major focus of the province’s annual gathering of OB-GYNs.

“We have a degree of trust both ways with the practicing community,” says Dianne Miller, Associate Professor in the Department of Obstetrics and Gynaecology and co-founder of OvCaRe. “We don’t have a lot of pushback, which is both a privilege and a huge responsibility. When we launched this, we had to be sure this was the correct thing to do.”

Tracking how much practice is actually changing is proving difficult, even in BC, because of the way such surgical procedures are coded.

“Anecdotally, we have heard from several major institutions around the province that it has become routine,” Dr. Miller says. “The dominoes are falling.”

Beyond BC, OvCaRe is relying on any willing ambassadors to spread the word. Jan Christilaw, Clinical Professor and President of BC Women’s Hospital and Health Centre, made the fallopian tube removal recommendation the focus of a lecture she gave at McMaster University. The President-elect of the Society of Obstetricians and Gynaecologists of Canada, Clinical Professor Mark Heywood, has vowed to make promoting the practice change a priority during his upcoming term, and has already given presentations about it at two of the society’s continuing medical education conferences.

“These articles go to press, it adds to the knowledge that’s out there, but there’s not always an immediate change in patient care,” Dr. Finlayson says. “Part of it is the medical establishment’s traditional deliberateness. Part of it is people just being very busy. So getting this new knowledge out takes time and energy.”

REPRINTED WITH PERMISSION FROM UBC MEDICINE, SPRING 2011, VOL. 7, NO. 1, Page 6-7