Where does this new advice come from?

The Ovarian Cancer Research Alliance, a leading cancer research group, recently posted a consensus statement encouraging patients to consider preventive fallopian tube removal if they are undergoing pelvic surgery for another noncancerous condition including hysterectomy, tubal ligations, cysts and endometriosis. The group notes that because “the fallopian tube is the origin of most high-grade serous cancers, fallopian tube removal has been shown to dramatically reduce risk for a later ovarian cancer diagnosis.” The group’s recommendations, first reported in the New York Times, also encourage women and anyone born with ovaries to learn more about their genetic risk for ovarian cancer. Those who have BRCA1 and BRCA2 cancer genes or a strong family history of ovarian cancer are routinely advised to have fallopian tubes and ovaries removed after childbearing is complete or not planned.

Why is fallopian tube removal for more women being recommended?

Efforts to identify a screening test for ovarian cancer have failed. A large British clinical trial used scans and blood tests hoping to find ovarian cancer at an early stage, but the results showed the screening tests didn’t reduce deaths from the disease. “We knew it was an important study. We knew that we needed to change the dialogue because we’re the largest ovarian cancer organization in the world and we had a responsibility,” said Audra Moran, president and chief executive of the Ovarian Cancer Research Alliance, or OCRA. “We also knew it wouldn’t be a popular message,” Moran said, explaining the concept that early detection saved lives was ingrained in the community. “This study very clearly shows that it doesn’t.” Kamal noted that while mammograms can identify early stage breast cancers, “there’s not a mammogram equivalent for the ovaries and the fallopian tubes.” Ovarian cancer is not common, but it is deadly and often occurs in women with no known risk factors. According to the American Cancer Society, every year 19,710 women in the United States are diagnosed with ovarian cancer and about 13,000 women die of it. Bhavana Pothuri, a gynecologic oncologist at NYU Langone, said there’s been a “shift in thinking” in recent years, based on recent research, leading gynecologists to recommend fallopian tube removal rather than tubal ligation, where the tube is tied or clamped to prevent future pregnancies. Fallopian tube removal “is becoming standard practice,” Pothuri said. “Removing the fallopian tubes is a simple procedure. And doesn’t impact your hormonal function,” Pothuri said. “It’s almost a no-brainer to take it out. Especially if you’re undergoing surgery for a hysterectomy."

How much weight do the OCRA recommendations carry?

Karen H. Lu, chair of the department of gynecologic oncology and reproductive medicine at the University of Texas’s MD Anderson Cancer Center, said that the statement from OCRA “amplifies a message that has been kind of underreported.” “Very few women know that the most common and most aggressive ovarian cancers start in the distal fallopian tube,” she said. “Very few doctors know.” Sarah DeFeo, chief program officer with OCRA, said although there is increasing awareness in the medical community, many women may not know the procedure is available to them. “Right now, a lot of women have never heard of this, so they’re just relying on their provider to bring it up,” she said. “If we can increase awareness of this as an option for women,” it gives women the opportunity to initiate the conversation, she added. “It’s an equity issue as well as to empower women to ask their doctors the question.” Stephanie V. Blank, president of the Society of Gynecologic Oncology, said that OCRA asked the society whether it would endorse the statement, and the SGO board did so in October. “We are very happy” that OCRA drew attention to the issue, said Blank, who is also the director of gynecologic oncology at Mount Sinai Health System in New York. Blank said OCRA’s statement represents a pivot from the group’s previous emphasis on looking out for symptoms of ovarian cancer and early detection. She and other cancer specialists said that women and their doctors should consider the possibility of having their fallopian tubes removed, because there is no effective early screening for the disease. Blank said there is little data showing how commonly doctors discuss the possibility with their patients, saying she suspects the rate varies in different regions of the United States and depending on whether a physician is affiliated with an academic medical center, where there may be more familiarity with the idea. In late 2013, SGO issued its own recommendations that removing fallopian tubes in women at average risk of ovarian cancer, who are done having children and planning a hysterectomy or other pelvic surgery “may be appropriate and feasible as a strategy for ovarian cancer risk reduction.” The American College of Obstetricians and Gynecologists said in 2015 and reaffirmed in 2020 that removal of fallopian tubes while women are having other types of gynecologic surgery could be “an opportunity to decrease the risk of ovarian cancer.” ACOG also noted that while the procedure reduces risk, it doesn’t eliminate risk entirely.

How many people are affected by this advice?

It’s unclear exactly how many women, trans or nonbinary patients would be candidates for fallopian tube removal. But about 4 million gynecologic surgeries are performed each year in the United States, including about 600,000 hysterectomies , which is surgical removal of the uterus, as well as tubal ligations, removal of fibroids or cysts and other procedures Evan R. Myers, a professor of obstetrics and gynecology at the Duke University School of Medicine, said that in the past decade, gynecologists have been removing the fallopian tubes more often during hysterectomy surgeries, Myers said. “The whole rationale for this is that screening for ovarian cancer doesn’t work,” Myers said. “And it’s probably because of the biology of the disease. It’s unlikely that there ever will be a screening test for it. So, this is kind of what we’re left with as primary prevention.” Moran said researchers are looking at which surgical procedures would make sense to pair with an opportunistic salpingectomy. “Researchers are exploring casting a slightly wider net,” possibly removing the fallopian tubes during other operations in the pelvic region, she said. A new foundation called Break Through Cancer, which is funding research at five leading U.S. cancer centers to study four intractable cancers, including of the ovary, is sponsoring a project to encourage general surgeons to consider removing fallopian tubes in women past childbearing age while operating elsewhere in the abdomen. This could include gallbladder or bladder surgery, hernia repair, or appendectomy. “What this project is promoting is that there are a lot of women who are undergoing surgeries where removing fallopian tubes could be done at very little risk,” said Tyler Jacks, Break Through Cancer’s president who is the founding director of MIT’s Koch Institute for Integrative Cancer Research. After women are beyond the point of becoming pregnant, “Fallopian tubes are vestigial,” Jacks said. The project “is trying to make the case this is a safe thing to do [and], would have clear medical benefit” in lowering the risk of ovarian cancer.

Should I have my tubes removed even if I’m not planning another surgery?

Nobody is recommending the procedure for people at average risk if no other surgery is planned. Kamal said those who don’t have a strong family history of ovarian cancer shouldn’t necessarily rush to talk to their doctors about tube removal. “This is not an absolute where every woman who’s having a benign procedure should absolutely have their fallopian tubes removed,” Kamal said. “This is saying: ‘Should be given the option.’”

What happens during surgery for fallopian tube removal?

Surgical removal of the fallopian tubes is called a bilateral salpingectomy, and it’s also a permanent form of birth control. Recovery typically takes one to three weeks and the procedure typically requires general anesthesia, according to Johns Hopkins . But recovery could take longer depending on what other surgery is performed at the same time. If a salpingectomy is performed with a laparoscope, it typically requires only three small incisions near the navel and in the lower abdomen. According to Johns Hopkins , the surgeon will use a tweezer-like instrument to grasp the tube and detach it from the ovary and uterus, sealing blood vessels to prevent bleeding.

Will I still have periods or the ability to get pregnant after fallopian tube removal?

The fallopian tubes aren’t involved in menstruation, so you’ll continue to have periods after salpingectomy, reports the Cleveland Clinic. Bilateral salpingectomy is a permanent form of birth control because the egg can no longer reach the uterus. Some people may have had only one fallopian tube removed, and in those cases, pregnancy can still occur. A person who has a bilateral salpingectomy but still has a uterus could get pregnant through in vitro fertilization.

Should ovaries also be removed during fallopian tube surgery?

Ovary removal, called oophorectomy, is discouraged unless a person has a known cancer gene or a strong family history of ovarian cancer, or another condition that might warrant the surgery. Even after childbearing is over, ovaries continue to serve important functions, supplying women with needed hormones that protect them from heart attacks and thinning bones and influence the sex drive. And removal of the ovaries in younger women will result in an abrupt surge into menopause. The risk of developing ovarian cancer for most women is relatively low, DeFeo said. “I don’t think anybody is recommending that your average-risk woman — without a strong family history, with no genetic mutation — should go under the knife and have her tubes and ovaries removed,” she said. “Nobody would suggest that because there are downsides. There are risks with surgery and there are risks of going into early menopause.”

Fallopian tube removal advised for more women to prevent ovarian cancer

In some cases, those who are done with childbearing may be advised to have tubes removed if they are having another gynecological surgery anyway

By Teddy Amenabar

Amy Goldstein

and

Lindsey Bever

February 2, 2023 at 3:40 p.m. EST

Listen

10 min

To prevent more cases of ovarian cancer, a major research and advocacy group is suggesting an aggressive prevention strategy: remove a woman’s fallopian tubes if she is undergoing pelvic surgery for another reason.

The practice would apply to women, trans men or nonbinary people at average risk who don’t plan to have any or additional children. The fallopian tubes are hollow structures that allow eggs to travel from the ovaries to the uterus.

The guidance to remove them, included in a new consensus statement from the Ovarian Cancer Research Alliance, is not entirely new — it reflects conversations many doctors already have with their patients and mirrors guidelines from at least two medical groups.

But the advice is certain to draw increased attention to fallopian tube removal as a way to lower ovarian cancer risk.

“I can guarantee you these conversations happen,” said Arif Kamal, chief patient officer for the American Cancer Society. “This is now an important group that has come out and said ‘We really do think these conversations should happen pretty regularly.’”

Here are answers to common questions about the recommendations, what’s involved with fallopian tube surgery called an opportunistic salpingectomy and whether more people should consider it.

Fallopian tube removal advised for more women to prevent ovarian cancer

In some cases, those who are done with childbearing may be advised to have tubes removed if they are having another gynecological surgery anyway

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