Outsmart Ovarian Cancer With One Surgery

 One 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.

The 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.

Mounting evidence shows that women who undergo bilateral salpingectomy have a substantially reduced risk of developing ovarian cancer. And several medical organizations, including the American College of Obstetricians and Gynecologists, endorse the procedure as an option for ovarian cancer prevention.

But many surgeons, and therefore patients, remain unaware of it.

“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,” Rebecca L. Stone, MD, a gynecologic oncologist and surgeon at Johns Hopkins Medicine, Baltimore, told Medscape Medical News.

“That’s just soul-crushing to me,” Stone said.

Beating the Silent Killer

Every year in the US, about 21,000 women are diagnosed with ovarian cancer, and roughly 80% have the more lethal subtype — high-grade serous carcinoma. 

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.

Earlier this month, a research letter 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. 

“This is [a] study at the population level to calculate the risk reduction from salpingectomy when done truly opportunistically — for the purpose of ovarian cancer prevention — during other gynecologic surgeries,” author Gillian Hanley, PhD, of the University of British Columbia in Vancouver, Canada, told Medscape Medical News.

During follow-up, 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% (hazard ratio, 0.22; 95% CI, 0.05-0.95).

Prior studies have shown that opportunistic salpingectomy adds about 5-13 minutes to another planned surgery, is low-risk, and appears cost-effective.

“We encourage all surgeons who do pelvic and/or abdominal surgery to discuss opportunistic salpingectomy with their patients who do not want any future pregnancies,” Hanley said.

She stressed that no one is recommending that all postreproductive women undergo salpingectomy because surgery always carries some degree of risk.

“However,” Hanley said, “if there are other surgical opportunities presenting themselves, we know that adding salpingectomy…is safe, low-cost, and a very effective way to reduce risk for ovarian cancer.”

Growing Awareness

Recently, 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.

“Ovarian cancer is frequently detected late, with devastating outcomes,” session moderator Joseph V. Sakran, MD, MPH, executive vice-chair of surgery at Johns Hopkins Medicine, said in a news release. 

“Although ovarian cancer might initially seem like a challenge best left to gynecologic oncologists,” he added, “exploring other opportunities to prevent ovarian cancer with general surgeons is critical.”

It’s been estimated that incorporating opportunistic salpingectomy into 60% of eligible surgeries could prevent nearly 6000 ovarian cancer deaths every year. 

“For those of us caring for patients with ovarian cancer, this isn’t just a statistic but is less pain and suffering in our clinics and fewer lives lost,” Kara C. Long, MD, of Memorial Sloan Kettering Cancer Center in New York City, said in the release.

Stone, Sakran, and Long have led the charge in raising awareness around opportunistic salpingectomy for ovarian cancer prevention in the US. They recently launched outsmartovariancancer.org — the first publicly available hub dedicated to information about ovarian cancer prevention with a special focus on opportunistic salpingectomy. 

Meanwhile, in September, the American Cancer Society partnered with the Break Through Cancer foundation to educate clinicians and the public about the benefits of opportunistic salpingectomy. 

Importantly, policy is also catching up. 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).

“Our goal is to help patients understand that this procedure may be an option for them during a planned pelvic or abdominal surgery,” Long said. “We want patients to have a choice.”

https://www.medscape.com/viewarticle/how-outsmart-ovarian-cancer-one-surgery-2026a10004hn