Experts are advocating for the removal of fallopian tubes, a procedure known as opportunistic salpingectomy, as a significant strategy to reduce the risk of ovarian cancer by up to 80%. This approach is gaining momentum as research indicates that the vast majority of the deadliest ovarian cancers originate in the fallopian tubes rather than the ovaries.
Ovarian cancer is a challenging disease to detect early, often earning the moniker 'silent killer.' In the UK, it affects over 7,000 women annually, with nearly four in five cases diagnosed at a late, incurable stage. Consequently, approximately 4,000 British women die from the disease each year. Symptoms are frequently vague and only appear after the cancer has spread.
The Origin of Ovarian Cancer
Growing evidence over the past two decades suggests that nearly all ovarian cancers, particularly the most aggressive forms, begin in the fallopian tubes. These 10-centimeter-long ducts, which transport eggs from the ovaries to the uterus, can harbor precancerous cells that eventually implant in the ovaries. Initial theories posited this origin, but faced skepticism until further research confirmed it.
Removing the fallopian tubes before these cells can develop in the ovaries has been shown to significantly decrease the risk of ovarian cancer. The remaining cancers that do originate in the ovaries tend to be less lethal and more treatable.
Opportunistic Salpingectomy
Opportunistic salpingectomy, when performed alongside other abdominal surgeries, adds minimal time and risk to the procedure. Health bodies in the UK and US are considering recommending that doctors offer this procedure to women over 45 who are undergoing abdominal surgery and no longer wish to have children. Unlike the removal of ovaries, which induces premature menopause, salpingectomy does not carry the same long-term risks of heart disease, osteoporosis, or dementia.
This procedure is already being offered to women in the UK as part of a national research trial. For women with a high genetic risk, such as those with BRCA1 or BRCA2 mutations, the standard preventative surgery remains the removal of both ovaries and fallopian tubes. However, this can lead to early menopause in premenopausal women, with associated health risks despite hormone replacement therapy.
EastEnders actress Kara Tointon, who tested positive for the BRCA1 gene mutation in 2018, opted to participate in the PROTECTOR trial. She had her fallopian tubes removed in 2024, allowing her to potentially preserve her ovaries longer while still significantly reducing her cancer risk.
Broader Application and Considerations
Experts like Professor Richard Edmondson suggest that opportunistic salpingectomy should be offered to all women undergoing abdominal surgery where it can be done easily and safely. He stated, "Any woman who is undergoing surgery where this procedure can be carried out easily and without additional risk should be offered it."
While the procedure is considered safe, potential risks include bleeding, infection, and accidental injury to nearby organs. It also does not prevent all forms of ovarian cancer, as approximately 20% originate in the ovaries. Some experts caution that women might develop a false sense of security, potentially delaying treatment if symptoms arise.
The British Gynaecological Cancer Society updated its guidance in 2024 to recommend that opportunistic salpingectomy be considered for average-risk women who have completed childbearing and are undergoing routine abdominal surgery. International bodies have also endorsed the procedure. However, awareness and surgeon training remain factors in its wider adoption.