Ovarian cancer has long been one of the deadliest cancers to strike women.
No tests are available to detect it early, so most patients are diagnosed in later stages, when the cancer is more likely to have spread. Fewer than half of women survive 5 years past their diagnosis, and 80 percent have no known risk factors.
Now, a growing chorus of physicians is recommending a procedure that can significantly reduce the chances of developing ovarian cancer. The procedure is called a salpingectomy — or removal of the fallopian tubes, where the majority of ovarian cancer cases begin.
The operation, advocates say, is short, relatively simple, and safe.
Some surgeons already offer salpingectomies to women who are done with childbearing and are undergoing other procedures, such as tubal ligation for permanent birth control, the removal of cysts or fibroids, or a hysterectomy. Researchers are now exploring whether to offer the surgery more widely.
“Removing the fallopian tubes is proven to be a safe addition to a hysterectomy, because the amount of time it takes to do a removal of the fallopian tubes is really a couple of minutes,” said Dr. Michael Worley, director of ovarian cancer surgery at Brigham and Women’s Hospital and Dana-Farber Cancer Institute and an assistant professor at Harvard Medical School.
Worley is part of an initiative among five top cancer centers, including Dana-Farber, MIT’s Koch Institute for Integrative Cancer Research, and New York’s Memorial Sloan Kettering Cancer Center, to make more women and physicians aware of the procedure.
The initiative, called Break Through Cancer, focuses on finding new ways to prevent and treat four of the deadliest cancers, including ovarian.
The group is not alone in promoting the strategy. The Ovarian Cancer Research Alliance, a leading ovarian cancer research organization, released new guidance Jan. 30 “encouraging those who are undergoing pelvic surgeries for benign conditions ... to consider having their fallopian tubes removed.”
A woman’s risk of developing the disease is 1 in 78, according to the American Cancer Society. Most cases occur in post-menopausal women, with half of all cases occurring in women 63 years or older. Women with breast cancer, family histories of ovarian cancer, or endometriosis are also at higher risk.
Research suggests that salpingectomies can significantly lower, if not eliminate, the risk of ovarian cancer. A 2022 Canadian study of nearly 26,000 women who had their fallopian tubes removed in place of tubal ligation or in addition to a hysterectomy found zero cases of the most deadly type of ovarian cancer among them.
The recovery time from a salpingectomy alone is estimated to range from a few days to two weeks. Although, coupled with another procedure, the recovery process would vary based on the primary surgery.
Worley recommended the procedure to his patient, Sandra, who came in complaining of irregular bleeding and was found to have several large fibroids in her uterus last year. She did not want her last name used to protect her privacy.
“He explained how, a lot of the times, keeping the tubes [can lead to] cancer so, I decided to go with the full procedure,” she said.
The Stoneham resident had already battled thyroid cancer and cared for both of her parents and her husband through various cancer diagnoses. So, she decided to get a salpingectomy in November, along with the hysterectomy that removed her fibroids.
The removal of the fallopian tubes does not interfere with the menstrual cycle, unlike removing the ovaries, which triggers menopause in patients who have not already gone through the process and increases the risk of other health issues, like heart complications and sexual dysfunction.
“In terms of preventing cancer [in women at higher genetic risk], the paradigm is shifting from taking tubes and ovaries to just take fallopian tubes and examining them to make sure that the patient isn’t at risk for a later recurrence,” said Dr. Chris Crum, a professor of pathology at Harvard University and the director of Women’s and Perinatal Pathology at Brigham and Women’s Hospital.
Currently, women at higher genetic risk, either due to family history or genetic mutations, are recommended to have their ovaries removed. The National Comprehensive Cancer Network recommends the removal of ovaries and fallopian tubes for women ages 35-40 with BRCA1 mutations and 40-45 with the BRCA2 mutations.
However, Crum said he imagines more women with BRCA gene mutations may elect to keep their ovaries given that “most of the risk will be removed by just taking out the fallopian tubes.”
A salpingectomy, on its own, is also an effective form of sterilization for women who are not interested in having future children. Many women already get parts of their tubes removed during tubal ligation, a procedure to cut, tie or block the tubes to prevent future pregnancies, the most common form of contraception worldwide.
A 2021 study found that salpingectomies are “as safe and efficacious as tubal ligation for sterilization and may be preferred, where appropriate, to reduce the risk of ovarian cancer.”
But, for women who are still interested in having children, pregnancy is possible through in vitro fertilization, if the uterus is not removed.