Ovarian Cancer Prevention: Should You Consider Getting Your Fallopian Tubes Removed?

 

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Women who are having routine pelvic surgeries should consider also getting their fallopian tubes removed to prevent ovarian cancer, the Ovarian Cancer Research Alliance said last week.

The most aggressive type of ovarian cancer often begins in the fallopian tubes, so if a person decides that they are finished with childbearing, their fallopian tubes can be removed as a preventative measure.

Though the recommendation is not mandated or necessary, experts hope it will spark more conversations between patients and their doctors about the potential benefits of getting the procedure.

In the absence of quality screening options for ovarian cancer, a leading advocacy and research organization is calling for more women or people born with ovaries to consider having their fallopian tubes removed, regardless of genetic risk status, in order to avoid ovarian cancer.

The recommendation, published in a statement last week, comes from the Ovarian Cancer Research Alliance. It encourages removal of the fallopian tubes during other pelvic surgeries for benign conditions—such as hysterectomy, tubal ligations, cysts, and endometriosis—as long as women are finished having children.1 

“Once women are done with childbearing, the [fallopian] tubes don't do a whole lot,” Susan Modesitt, MD, director of gynecologic oncology at Winship Cancer Institute of Emory University, told Health. “[We can] take those out earlier without really any detrimental effects.”

Despite its name, most ovarian cancers—and the most aggressive type of ovarian cancer tumors—originate in the fallopian tubes.2 Since fallopian tubes aren’t necessarily beneficial after childbirth, removing them can greatly reduce the risk of developing ovarian cancer, which is the most deadly gynecological cancer, Dr. Modesitt explained. 

In addition to recommending this preventative surgery, the OCRA also encouraged healthcare providers to learn more about ovarian cancer symptoms so that patients can receive more prompt diagnoses, and to promote genetic testing so people can be more aware of their risk, among other things.1

Here’s what experts had to say about the OCRA recommendation, why this is the best available option for preventing ovarian cancer, and how healthcare may look different for patients going forward.

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Expanding On a Preexisting Prevention Method 

Though the recommendation is newly made, the idea of removing fallopian tubes to reduce the risk of cancer is not new.

In the same way that people can be at an increased risk of breast cancer if they have certain genetic mutations, certain people can also be at an increased risk of getting ovarian cancer if they have mutations in the the BRCA1 and BRCA2 genes.34

For that group, doctors have been recommending salpingectomies—or fallopian tube removal surgeries—and ovary removal surgeries for over two decades, explained Oliver Dorigo, MD, PhD, director of the division of gynecologic oncology at Stanford University. Researchers found that some of these patients had very early stage cancers that started off in the fallopian tubes, rather than the ovaries.

If the surgery is performed in order to prevent ovarian cancer at the same time as another pelvic surgery, it's called an opportunistic salpingectomy.

“That [insight] prompted the idea that removal of the fallopian tube might actually prevent ovarian cancer—not only in those patients that have genetic mutations, but also in the general population,” Dr. Dorigo told Health. 

As far back as 2013, the Society of Gynecologic Oncology—which also endorsed the OCRA’s latest statement5—recommended that average population women should consider having their fallopian tubes removed if they’re getting a hysterectomy, a procedure to remove the uterus, or other pelvic surgeries, such as getting their fallopian tubes tied.6

But after the publication of a 2021 study that found that ovarian cancer screening and symptom awareness had no effect on saving women’s lives, the conversation about fallopian tube removal as an effective prevention tool was reignited.7 The findings prompted OCRA to make their recommendation. 

“Symptom campaigns aimed at people saying, ‘It’s going to save your life to know the symptoms,’ just [aren't] true,” Audra Moran, president and CEO of the OCRA, told Health. “We wanted people to refocus their efforts to something that could actually affect change and save lives.” 

 

Why Doesn’t Less-Invasive Prevention Work? 

It’s not unusual for cancer screening to be a part of normal healthcare for the general population, whether it’s getting a colonoscopy, pap smear, or mammogram to screen for early signs of colon cancer, cervical cancer, or breast cancer, respectively. And though some tests have been used to screen for ovarian cancer—doctors can administer a pelvic exam, a transvaginal ultrasound, or a CA-125 assay—they don’t actually help reduce deaths from ovarian cancer, Dr. Modesitt said.8 

Currently, there are no screening tests that are recommended for women of average risk or for women with no symptoms.9

“You pick up benign things that would never become cancer and people have to have an unnecessary surgery,” she said. “And even if occasionally you pick [the cancer] up at an earlier stage, there’s no improvement in survival or outcomes.”

In the 2021 study the OCRA partly based their recommendation on, even women who had their cancer identified at stage 1 or 2, saw no specific benefits in cancer mortality—despite the fact that researchers estimated they were diagnosed an average of 18 months before their symptoms would have started.

In the same study, however, some women who were diagnosed with later-stage ovarian cancer did “very well” and weren’t necessarily sentenced to a poorer prognosis. This, according to researchers, likely has something to do with how aggressive or not their cancer was—regardless of staging.

The reality of ovarian cancer is that it is not as straightforward as other cancers. It is “highly heterogeneous” which means that the term “ovarian cancer” can refer to many unique types of cancers. According to the OCRA, this may help explain why some late-stage patients are able to go into remission and be cured, and some early-stage patients may end up dying from the disease.

Ovarian cancer also grows differently than other solid tumors: It typically starts off as tiny cancerous cells in the fallopian tubes. Instead of growing into a solid tumor and then spreading around the body, those tiny cancerous cells first spread throughout the abdomen before then growing to a size that doctors can spot during a test or screening, Dr. Modesitt added.

The symptoms of ovarian cancer—which can include bloating, pelvic pain, fatigue, and urinary urgency—are also nonspecific, meaning they can be attributed to a number of other conditions. Women are also likelier to have these symptoms once the disease has spread and progressed past early stages.1011

According to the OCRA, “people diagnosed with ovarian cancer and their families should be freed from the burden of believing that if only they had recognized and acted on the symptoms earlier, they would have a vastly different outcome, as we know this is not the case.”

These facts are why, for now, experts believe the best way to prevent ovarian cancer is to go right to the source and remove fallopian tubes if a person won’t need them in the future for childbearing. 

 

A Small Procedure With Big Benefits

Though this is certainly a more invasive preventative procedure than some others, the recommendation may not have a huge impact on how people with fallopian tubes experience healthcare in the future.

For one, the recommendation only applies to general population women who are already having some sort of pelvic surgery. Women who are at high risk of ovarian cancer may be able to have their fallopian tubes and ovaries removed as early as age 35, Dr. Dorigo said. But for people who are at average risk, the surgery can only be done if it’s added to another pelvic surgery.

And that additional surgery to get the fallopian tubes out may be pretty simple, generally speaking. The salpingectomy may only take five to 10 minutes if added to another procedure, Dr. Modesitt said.

And unlike ovaries—which produce hormones and help prevent heart disease and cancer, among other things—a person likely won’t notice any changes at all after removing their fallopian tubes.12

“The fallopian tubes do not produce any hormones,” Dr. Dorigo said. “There should not be any functional deficits in patients that underwent fallopian tube removal.” 

And the procedure seems to work. A 2022 study found that a group of women who received fallopian tube removal surgeries saw no serious ovarian cancer cases.13

Of course, the fallopian tube surgery doesn’t come without its possible complications. As is the case with any surgery, there’s always the possibility of some kind of issue with bleeding or an infection, experts agreed. And, of course, the procedure isn’t a complete guarantee that a person will never get ovarian cancer, Dr. Modesitt added.

But for people with fallopian tubes, care for ovarian cancer prevention will only change if they want it to. The OCRA’s statement is not binding.

“It isn’t like, ‘You absolutely should do this or you’re going to get ovarian cancer.’ That sounds scary. And that is not true,” Moran said. “But again, if this is something you can do that won’t make a difference to you, your health, your body, it won’t change anything about you as a person and you’re already having the surgery, then at least talk about it.”

Opening Up the Conversation 

More than anything, the OCRA statement is meant to be a reminder to both doctors and their patients to be aware of the benefits of this preventative procedure, and spend some time discussing whether it might be a good option.

There are an estimated 600,000 hysterectomies performed in the U.S. each year, which doesn't include the number of other pelvic surgeries that people with fallopian tubes might be getting. So if this were to be adopted more widely, explained Sarah DeFeo, chief program officer of the OCRA, it could have a big impact on ovarian cancer rates.

“These are surgeries that these women are going to be having anyway, so it seems like a lot of upside, not a lot of downside,” DeFeo told Health. “This is actually something that the average woman can do to prevent what’s a really deadly cancer. While not super common, it’s very deadly. So this is a huge opportunity.”

In addition to the fallopian tube removal, people can also consider speaking with their doctors about other ways to get on top of ovarian cancer. That can include using birth control, which lowers the risk of ovarian cancer.14 

The OCRA statement also included recommendations that people with fallopian tubes seek out genetic testing to determine whether or not they’re at an elevated risk, learn more about ovarian cancer symptoms, and consider participating in clinical trials to advance knowledge about the disease.15

“Ovarian cancer, at this time, is caught at very late stages when cure rates are low,” Karen Lu, MD, chair and professor of gynecologic oncology and reproductive medicine at the University of Texas MD Anderson Cancer Center, told Health. “And if a woman has an opportunity to prevent the disease, then we want to make sure that they are empowered to have that conversation with their doctor.”

 

  By Julia Landwehr
Photo of Julia Landwehr.
Fact checked by Nick Blackmer