Public Health Reproductive Health Sterilization Women's Issues

Prevent Ovarian Cancer

Ovarian cancer is a terrible disease!


I have to make you sick to make you well,

            The oncologist says, five months

we’ll scour each cell of your abdomen clean.


It always burns, multiples thousands of bone splinters

stinging cells, murdering nerves, dulling

my mind, my spine alive, a drawn bow

aimed at heaven, sprouting agony’s three stingy feathers.

                        Both from Refugee; poems 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, like the Pap smear, for this terrible disease. Ovarian cancer has usually spread widely by the time that it is detected, so heroic treatment is required. Despite medical advances, most women who get ovarian cancer 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 puzzlingly, about a decade ago it was discovered that most ovarian cancers actually start in the Fallopian tubes.

Ovarian cancer is not that rare—about 1 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 just blocking a woman’s tubes 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 annually!

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, her tubes are exposed and this procedure only adds 5 minutes to the surgery.

Regrettably, that may not be possible in some hospitals under Catholic control. They must abide by the “Ethical and Religious Directives for Catholic Health Care Services” of the United States Conference of Catholic Bishops. 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 be able to breastfeed?

All healthcare institutions should endeavor to prevent illness and death. A study examined the number of women having tubal ligations at the time of cesarean birth and calculated that over 900 cases of ovarian cancer and 550 deaths every year in the USA could be prevented by doing salpingectomies for women who want sterilization at the time of cesarean.

Let’s look at this issue from a different viewpoint. What if it had been shown that vasectomy decreased the risk of testicular cancer (it doesn’t, unfortunately). Do you think that 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 MD, 2022

Abortion Public Health Women's Issues

Work Around New Antiabortion Laws

Number of Maternal Deaths from Abortion, data from the Guttmacher Institute

            Abortion has been practiced by all societies that anthropologists have studied. Most past ways of causing an abortion are either ineffective or dangerous—or both. Midwives prescribed herbs for centuries to cause abortion, but they can be fatal if the dose that is too large. Physical methods, like beating the woman’s swollen abdomen, were also frequent. Purposely falling down a flight of stairs was not uncommon. Perhaps the most frequent way of aborting a pregnancy in the 20th century, before Roe v. Wade, was to insert something into the uterus. Coat hanger wire or knitting needles were repurposed for this.

            Fifty years ago, when I was in general practice, I reviewed the chart of a woman in her 40s before meeting her. I learned that she had had a hysterectomy, then read the pathology report stating that there was a 6-inch splinter of wood found in the uterus.

            “How did it get there?” I asked innocently when I met her.

            “I don’t know” was her reply. Then it dawned on me.

            Other dreadful ways of attempting to terminate a pregnancy include douching with harsh chemicals, shooting the fetus while in the uterus, and suicide. The maternal mortality rate in the USA dropped precipitously in 1973 when the Supreme Court legalized abortion in all states. I fear that the Dobbs decision will cause an increase in our country’s already high maternal mortality rate.

            Death is not the only problem caused by making abortion illegal or unobtainable in many states. A good friend of ours had an illegal abortion in the 1960s, but was unable to conceive later when she was married. It is likely her unsafe abortion caused an infection that prevented the desired pregnancy.

            In the past, women in Chicago took abortion care into their own hands—literally. The Jane Collective learned how to perform abortions safely and did so in the apartments of willing tenants, thereby escaping police detection. A California psychologist, Dr. Karmen, helped women by developing aspiration instruments for “Menstrual Extraction”. To avoid the abortion laws, ME was done before pregnancy was diagnosed. And the Clergy Consultation Service, established in New York, referred women nationally to willing physicians for safe abortions.

            Since the Supreme Court’s Dobbs decision made it possible for states to outlaw abortion again, other ploys are being used to help women access safe abortions. Most take advantage of medication abortion, using 2 FDA-approved pills. Mifepristone and misoprostol are available by Internet; however, they are expensive and can take weeks to arrive. The advent of telemedicine has improved access in the USA.

            One plan is to have access to the medication available just over the border in a state that allows abortion. There is a new clinic in New Mexico, a few miles from Texas, so women can get the abortion pills if they cross the border. Planned Parenthood in Illinois will be providing the same service from a van for residents of Missouri and other neighboring states. Perhaps the most innovative work-around is in Arizona. Camelback Family Planning will perform the ultrasound and counseling, then the information is sent to a California doctor who then prescribes the medication. The woman picks up her pills at a post office in a California border town—all free, thanks to the Abortion Fund of Arizona.

            There are several funds that help women get to abortion clinics and also aid with the cost of abortion care, some local and some national. I donate to both Colorado’s Cobalt Abortion Fund and to the National Network of Abortion Funds—both are tax deductible.            

Almost 60 years ago the Clergy Consultation Service found ways around the laws that prohibited abortions. Now we have their experience, plus Internet and medication abortion. Although Dobbs is a setback, today women are better off than before Roe.

© Richard Grossman MD, 2022