How to Outsmart Ovarian Cancer With One Simple Add-on Procedure
A simple add-on procedure to routine pelvic surgeries could potentially prevent thousands of deaths from ovarian cancer every year. Yet most women are never told it’s an option. This procedure, called opportunistic bilateral salpingectomy, involves removing both fallopian tubes during an unrelated pelvic surgery, such as a hysterectomy, in women who are past their childbearing years. The procedure has been endorsed by several medical organizations, including the American College of Obstetricians and Gynecologists, as an option for ovarian cancer prevention.
But many surgeons, and therefore patients, remain unaware of it. Rebecca L. Stone, MD, a gynecologic oncologist and surgeon at Johns Hopkins Medicine, Baltimore, told Medscape Medical News, "We are now in a position where we can outsmart a disease that has eluded us for centuries, but if doctors don’t bring it up, women won’t know."
Ovarian cancer is known as the silent killer because it lacks reliable screening methods and typically causes no obvious symptoms in the early stages. Most patients are diagnosed with advanced disease, and in the US, about half survive for 5 years. Researchers have known for years that many, if not most, ovarian cancers originate in the fallopian tubes rather than the ovaries themselves. That raised the possibility that removing the fallopian tubes, which serve no function in a woman’s postreproductive years, could avert many ovarian cancers.
Several large population-based studies have confirmed that potential, and a 2023 systematic review concluded that salpingectomy was associated with a roughly 80% reduction in ovarian cancer risk. A recent study in JAMA Network Open backed that up. The retrospective cohort study analyzed data from all women who had a hysterectomy or tubal permanent contraception in British Columbia, Canada, between 2008 and 2020. Among 85,823 women, 40,527 underwent opportunistic bilateral salpingectomy, while 45,296 underwent a hysterectomy alone or tubal ligation.
The study found that there were 21 serous ovarian cancers diagnosed in the comparison group, compared with five or fewer in the group that underwent opportunistic bilateral salpingectomy, amounting to a risk reduction of nearly 80%. Prior studies have shown that opportunistic salpingectomy adds about 5-13 minutes to another planned surgery, is low-risk, and appears cost-effective.
There has been a growing push to make both gynecologic and general surgeons aware of opportunistic salpingectomy. At its annual meeting last November, the American College of Surgeons held a session where panelists urged greater integration of fallopian tube removal into routine non-gynecologic procedures such as gallbladder removal and hernia repair. Incorporating opportunistic salpingectomy into 60% of eligible surgeries could prevent nearly 6000 ovarian cancer deaths every year.
The American Cancer Society and the Break Through Cancer foundation have partnered to educate clinicians and the public about the benefits of opportunistic salpingectomy. There is now a specific ICD-10-CM diagnosis code (Z40.82) for opportunistic salpingectomy (prophylactic removal of fallopian tube[s] without known genetic/familial risk). The goal is to help patients understand that this procedure may be an option for them during a planned pelvic or abdominal surgery, and to give them a choice.
