Salpingectomy for Ovarian Cancer Prevention

Many ovarian cancers start in the fallopian tubes. For some people, removing the fallopian tubes during another planned pelvic surgery may lower the risk of ovarian cancer while leaving the ovaries in place.

What is a salpingectomy (fallopian tube removal)? 

A salpingectomy is surgery to remove the fallopian tubes. The fallopian tubes are small, narrow tubes that carry eggs from the ovaries to the uterus. The female reproductive tract typically includes 2 fallopian tubes (and 2 ovaries), 1 on each side of the uterus. Removing 1 fallopian tube is called a unilateral salpingectomy. When salpingectomy is done for cancer prevention, both fallopian tubes are removed. This is called a bilateral salpingectomy.

Salpingectomy might be done for different reasons:

• To treat an ectopic pregnancy, infection, or other problem affecting the reproductive system
• For permanent birth control
• To help lower your risk of fallopian tube and ovarian cancer

Salpingectomy, when done by itself, is usually done as a laparoscopic surgery, which means it is a minimally invasive surgery that requires only small cuts in the abdomen. Salpingectomy might also be done at the time of hysterectomy or as part of another laparoscopic or open pelvic or abdominal surgery.  

Fallopian tube removal to prevent cancer

Scientists have found that most high-grade serous ovarian cancers, the most common and deadliest type of ovarian cancer, start in the fallopian tubes, not the ovaries. This means that removing the fallopian tubes might lower the risk that this type of cancer will ever develop.

Opportunistic salpingectomy is the removal of the fallopian tubes during a planned pelvic surgery that's being done for another reason. It's an added step during an operation you're already scheduled to have, such as a hysterectomy (removal of the uterus). In this situation, removing the fallopian tubes might be considered a preventive or risk-reducing procedure.

A preventive or risk-reducing salpingectomy might also be done in place of a tubal sterilization (also known as tubal ligation or "getting your tubes tied"). In this situation, the salpingectomy might be done because it has the same effect as tubal sterilization, but with the added benefit of lowering your risk of ovarian cancer.

When done at the time of another surgery, salpingectomy appears to be safe and does not increase the risk of complications.

Consideration of this approach is recommended for women at average risk of ovarian cancer who are already planning to have one of these surgeries.

Does removing the fallopian tubes completely prevent ovarian cancer?

Salpingectomy lowers the risk of ovarian cancer, but it doesn't remove the risk completely.

Studies have found that people who had a salpingectomy were much less likely to develop serous ovarian cancer than people who had similar surgeries without having their fallopian tubes removed.

Most of this evidence comes from observational studies done outside the United States. Researchers are continuing to study this procedure to learn more about its long-term benefits.

Who might benefit from opportunistic salpingectomy?

You may want to talk with your doctor about opportunistic salpingectomy if:

• You still have your fallopian tubes, and
• You are at average risk for ovarian cancer, and
• You are already having pelvic surgery for another reason, such as tubal sterilization or hysterectomy.

More than 1 in 5 adult women in the United States have a hysterectomy at some point. If you are considering either of these surgeries, talk with your doctor about whether removing your fallopian tubes at the same time makes sense for you.

Researchers are also studying whether this procedure can be safely added to other types of abdominal or pelvic surgery, such as gallbladder removal or surgery for diverticulitis.

Who might not benefit?

This procedure isn't right for everyone. You might not be a good candidate for opportunistic salpingectomy if:

• You may want to become pregnant in the future. Removing your fallopian tubes is a form of permanent birth control and cannot be reversed.
• You want surgery only to prevent ovarian cancer, with no other medical reason for the surgery. All surgery carries risks, such as bleeding, infection, or injury to nearby organs. General anesthesia (putting you into a deep sleep) carries risks, too. Because of these risks, doctors don't recommend this procedure as a stand-alone surgery for people at average risk.
• You have an inherited gene change, such as a BRCA1 or BRCA2 mutation, a history of premenopausal breast cancer, or a condition called deep infiltrating endometriosis.

If any of these apply to you, your doctor may recommend a different risk-reducing approach based on your specific situation.

Talk with your doctor about your health history, your plans for having children, and your personal risk factors before deciding if this procedure is right for you.

What to expect after salpingectomy

If you're premenopausal, it's important to know that salpingectomy is different from oophorectomy (removal of the ovaries). Salpingectomy does not cause menopause. If your ovaries and uterus are left in place, they keep working normally. Your ovaries still make hormones and release eggs, and you'll still get your period. The difference is that eggs can no longer travel to your uterus. This means you can't get pregnant without medical help, such as in vitro fertilization (IVF). Because your hormone levels don't change, salpingectomy usually doesn't affect your quality of life or overall health.

For some people at high risk, another surgery after menopause to remove the ovaries might be an option to lower ovarian cancer risk.

Are there other ways to lower ovarian cancer risk?

Yes. Other ways to help lower your risk include:

• Genetic counseling and testing: If you have a family history of breast or ovarian cancer, or if a known BRCA gene mutation runs in your family, genetic counseling and testing can help you find out if you carry an inherited gene change. This can help you and your doctor plan the most effective risk-reduction strategy for you.
• Hormonal birth control: Taking oral birth control pills for 5 or more years is linked to a lower risk of ovarian cancer. Talk with your doctor about whether this option is right for you, since birth control pills aren't safe for everyone.
• Lifestyle factors: Research on the links between diet, exercise, and ovarian cancer risk is still limited and not fully conclusive. Staying physically active and maintaining a healthy weight are linked to a lower risk of cancer overall.
• Progestin-containing IUD: Using a hormonal intrauterine device (IUD) for several years is linked to a lower risk of ovarian cancer.
• Having children: Women who have given birth have a lower risk of ovarian cancer than women who haven't, and risk tends to go down with each pregnancy. This isn't a reason to have children, but it's useful to know if you're weighing your personal risk factors.
• Breastfeeding: Breastfeeding, especially for a year or longer, is linked to a lower risk of ovarian cancer.

Talk to your doctor

Opportunistic salpingectomy is an evolving prevention strategy. It can lower the risk of ovarian cancer in people at average risk, but it might not be the right choice for everyone. Talk with your doctor about your risk factors and options, and together you can decide what approach makes sense for you.