“Shapeshifter”

I have to make you sick to make you well,

The oncologist says, five months

we’ll scour each cell of your abdomen clean.

– from “Refugee” by Pamela Uschuk

When I first learned that our friend Pamela Uschuk had ovarian cancer, I despaired for her life. Ovarian cancer is one of the worst killers. By the grace of God and the Mayo Clinic, she is still alive and well 10 years later.

Unfortunately, there is no screening test for this terrible disease. Ovarian cancer has usually spread widely by the time it is detected, so heroic treatment is required. Despite medical advances, most ovarian cancer victims are killed by it.

Mysteriously, the risk of getting ovarian cancer is reduced by using birth control pills, by tubal ligation or by hysterectomy. Even more puzzling, about a decade ago, it was discovered that most ovarian cancers actually start in the Fallopian tubes.

Ovarian cancer is not that rare – about one in 80 women will develop it. Some women are at higher risk because they carry a genetic mutation such as BRCA, but they only account for about one-tenth of the people who develop this disease. Pamela was at normal risk; she is BRCA negative.

Now, rather than tubal ligation to prevent pregnancy, it is recommended to consider removing the tubes entirely (salpingectomy). The final word isn’t in because the recommendation is too new, but bilateral salpingectomy has the possibility of preventing hundreds of cases of ovarian cancer, saving many lives.

If a woman has a planned Cesarean with what she intends to be her last child, why not have a salpingectomy at the same time? After all, this procedure only adds five minutes to the surgery and may save her life.

Regrettably, that may not be possible in some hospitals under Catholic control, including Mercy Regional Medical Center in Durango. They must abide by the “Ethical and Religious Directives for Catholic Health Care Services.” This document states:

“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present or serious pathology and a simpler treatment is not available.”

This statement has unintended consequences. Many women have hysterectomies in Catholic hospitals because the simpler, safer and less expensive tubal ligation is prohibited. Worse, this policy leads to unplanned pregnancies and abortions. Remember, the most effective way of preventing abortions is with effective contraception.

Of course, there is the option for the new mother to go to another hospital at a later time for her tubal surgery, but that means a second anesthesia, additional cost, plus more pain and recovery time. What mother wants to leave her newborn child and not breastfeed?

All health care institutions should endeavor to prevent illness and death. A 2018 study published in the American Journal of Obstetrics and Gynecology examined the number of women having tubal ligations at the time of Cesarean birth, and calculated that more than 900 cases of ovarian cancer and 550 deaths every year in the U.S. could be prevented by doing salpingectomies for women who desire sterilization at the time of Cesarean.

Let’s look at this issue from a different viewpoint. What if vasectomy decreased the risk of testicular cancer (it doesn’t, unfortunately). Do you think the Catholic patriarchy would deprive their priests and other men of this potentially life-saving surgery?

Preventing sterilization, especially salpingectomy, at the time of Cesarean is a case of religious doctrine standing in the way of good medical care.

Richard Grossman, M.D., is a retired obstetrics-gynecology physician who lives in the Bayfield area.