Updated guidelines from the American College of Obstetricians and Gynaecologists (ACOG) recommending the removal of fallopian tubes to reduce ovarian cancer risk, are grounded in data showing most ovarian cancers originate in the fallopian tubes, not the ovaries.
The removal of both fallopian tubes is called a bilateral salpingectomy; when the tubes are removed during another, unrelated surgery, it’s known as an opportunistic salpingectomy.
ACOG’s updated guidelines explain that many common abdominal and pelvic procedures including a hysterectomy (surgical removal of the uterus), tubal procedures for permanent contraception and even some non-gynaecologic surgeries, offer opportunities to reduce the risk of ovarian cancer through salpingectomy.
Once the fallopian tubes are removed, the patient cannot conceive without the help of in vitro fertilisation (IVF).
ACOG recommends OB‑GYNs perform salpingectomy in certain circumstances:
During a hysterectomy: OB-GYNs should routinely perform bilateral salpingectomy when patients undergo removal of the uterus.
During other pelvic or abdominal surgeries: for patients who don’t want any more children, OB‑GYNs should recommend bilateral salpingectomy during non-hysterectomy gynaecologic surgeries that enter the peritoneal cavity.
During eligible non-gynaecologic procedures: OB-GYNs should support other surgical specialists in offering opportunistic salpingectomy when appropriate.
“We now understand that many ovarian cancers begin in the fallopian tubes, giving us an important opportunity to prevent cancer before it develops,” said Kathleen Schmeler, professor of Gynaecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Centre, and member of the Foundation’s Medical Advisory Board.
There is no recommended routine screening for ovarian cancer for women at average risk, meaning opportunities are rare to detect and diagnosis ovarian cancer in early stages.
Only about 20% of ovarian cancers are found at an early stage, but when it is found early, the five-year survival rate is 94%.
The US Prevent Cancer Foundation encourages women to talk to their doctors about their personal risk for ovarian cancer and discuss steps to reduce their risk when possible.
The updated recommendations are grounded in data showing most ovarian cancers originate in the fallopian tubes, not the ovaries. Removing both tubes can reduce a patient’s lifetime risk of ovarian cancer by up to 78%, without affecting hormone production or ovarian function.
Clinical studies also indicate salpingectomy is as safe as tubal ligation, adds very little time to the surgery, and does not increase short- or long-term risks.
In some cases, it may be beneficial for women at higher risk for ovarian cancer to undergo a salpingo-oophorectomy, which is the removal of the ovaries and fallopian tubes.
Women at higher risk may include those with:
A known genetic mutation (BRCA1, BRCA2 or Lynch syndrome) associated with increased breast or ovarian cancer risk
A strong family history of ovarian, breast or colorectal cancers
No personal history of giving birth
Endometriosis (abnormal growth of tissue that lines the inside of the uterus)
Radiation exposure to the pelvis
A menstrual cycle that started before age 12
Menopause that started after 52
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