Good afternoon. Thank you very much for inviting me to speak with you today.
My name is Gillian Hanley, and I am an associate professor in the department of obstetrics and gynecology at the University of British Columbia and a tier 2 Canada research chair in population-based gynecological and perinatal outcomes.
I am also a member of the Gynecologic Cancer Initiative, along with Dr. McAlpine. The GCI is an interdisciplinary network of patients and family partners, clinicians and scientists who are all working across gynecological cancer disease sites, across institutions and across disciplines, with the goal of reducing death and suffering from gynecological cancer by 50% by 2034.
This is an important goal, since in this year alone, 12,000 Canadian women, transgender men and non-binary people will be diagnosed with a gynecological cancer. Gynecological cancers include cervical, endometrial, vulvar, vaginal and ovarian cancers, and they represent 10% of cancer deaths in women.
Importantly, funding for gynecological cancer does not reflect this disease burden. The Canadian Cancer Research Alliance has calculated that there has been a 60% higher investment per case in breast cancer research than in gynecological cancers. This disparity increases to a 270% higher investment in breast cancer when the numbers are based on cancer-related deaths. Thus, both national focus and dedicated investment are needed in this important area.
Despite these challenges, Canadian researchers have made important strides in understanding, treating and preventing gynecological cancers. There are many areas in gynecological cancer in which Canada is world-leading, including ovarian cancer prevention, which is the focus of my research.
Despite tremendous international effort, there is no effective screening method for ovarian cancer. Symptoms generally do not arise until the disease is in advanced stages, at which point five-year survival rates are well below 50%; thus, we have focused our efforts on preventing ovarian cancer.
There are five distinct types of ovarian cancer. Seventy per cent of ovarian cancers and 90% of deaths from ovarian cancer are from the high-grade serous type. Approximately 20 years ago, we discovered that most high-grade serous cancers arise in the Fallopian tube and not on the ovary, as was previously believed. Fallopian tubes connect the ovaries to the uterus, but they play no known role post-childbearing. This is not true of ovaries, which produce endogenous hormones that are important for women's long-term health. Thus, taking the opportunity to remove the Fallopian tubes during other gynecological and pelvic surgeries while leaving the ovaries behind has been a ground-breaking ovarian cancer prevention approach.
In 2010, our team in British Columbia launched the world's first population-based ovarian cancer prevention program. We recommended that salpingectomy, the removal of both Fallopian tubes, be performed at the time of hysterectomy, the removal of the uterus. We also recommended removal of Fallopian tubes rather than ligation or having one's tubes tied for permanent contraception. Recognizing that approximately 80% of ovarian cancers occur in people who have no genetically increased risk, we based this prevention effort not on risk for ovarian cancer but rather on opportunity. Hence, we called it opportunistic salpingectomy. We are taking an opportunity provided by another surgery to also conduct this important ovarian-cancer prevention strategy. This is now recommended practice in nine countries worldwide, including Canada. Through research, we've demonstrated the safety and feasibility of opportunistic salpingectomy, and in 2022, we provided the first evidence that removing Fallopian tubes does significantly reduce risk for ovarian cancer.
Despite these compelling data, a recent assessment of the pan-Canadian practice of Fallopian tube removal demonstrated considerable variation in uptake outside of B.C. The study estimated that between 2017 and 2020, nearly 80,000 Canadians received a tubal ligation or hysterectomy without Fallopian tube removal, representing a missed opportunity to stop ovarian cancer from developing and translating to a possible 1,000 future cases of ovarian cancer that could have been prevented.
My recommendations today are to increase the funding for gynecological cancer research to accurately reflect the burden of these cancers on Canadians and to target funding to groups that are multidisciplinary and working across cancer disease sites and institutions to make the fastest and most meaningful progress. We also recommend putting a focus on funding for implementation science to ensure that important research advances are available to Canadians and that the federal government consider engaging in communication strategies targeted to patients and clinicians to help get these important research advances to all Canadians.
Thank you very much.