Experts are increasingly recommending the removal of fallopian tubes as a strategy to drastically cut the risk of ovarian cancer, a disease often called the 'silent killer' due to its late-stage detection and high mortality rate. Research indicates that nearly all ovarian cancers, particularly the most lethal forms, originate in the fallopian tubes. Removing them, a procedure known as opportunistic salpingectomy, could reduce a woman's risk by up to 80 percent.
Ovarian cancer affects over 7,000 women in the UK annually, with one in 50 developing the disease in their lifetime. The cancer frequently shows few symptoms until it has spread, making early detection challenging. Consequently, nearly 80 percent of cases are diagnosed at a late, often incurable, stage, leading to approximately 4,000 deaths in Britain each year. Current screening methods have proven largely ineffective in catching the disease early enough to save lives, as shown by a 2023 British trial.
The theory that ovarian cancer begins in the fallopian tubes, rather than the ovaries, has gained traction over the past two decades. Studies have found precancerous cells often in the tubes, which then spread to the ovaries. Removing the fallopian tubes before these cells can develop is believed to be a key preventative measure.
For women at high risk due to genetic mutations like BRCA1 or BRCA2, or a strong family history, the standard preventative surgery has been the removal of both ovaries and fallopian tubes. However, this can induce premature menopause, bringing long-term health risks such as heart disease, osteoporosis, and potential cognitive decline. Opportunistic salpingectomy, by contrast, removes only the tubes, allowing women to retain their ovaries and avoid induced menopause.
This procedure is now being offered to women in the UK as part of research trials, such as the PROTECTOR trial, which Kara Tointon, an actress with a BRCA1 gene mutation, has participated in. Tointon opted for fallopian tube removal to preserve her ovaries, undergoing the procedure in 2024. She highlighted the straightforward nature of the surgery, which allowed her to leave the hospital the same day.
Growing numbers of medical professionals and organizations, including the British Gynaecological Cancer Society, the International Federation of Gynaecology and Obstetrics, and the European Society of Gynaecological Oncology, support offering opportunistic salpingectomy more broadly. They advocate for its consideration during routine abdominal surgeries for women who have finished childbearing. The procedure adds only about five minutes to existing surgeries and carries minimal additional risks, such as bleeding or infection, similar to any abdominal surgery.
Experts suggest that this procedure could benefit women with average or low risk of ovarian cancer as well. Professor Richard Edmondson, clinical professor in gynaecological oncology at the University of Manchester, stated that for women undergoing abdominal surgery, reducing their ovarian cancer risk by 80 percent represents significant progress. He added that it is a logical step for women who do not intend to have more children.
However, some experts caution against widespread adoption for average-risk women. Dr. Elaine Leung, a clinical lecturer in gynaecological oncology, warned that women might mistakenly believe they are entirely protected from ovarian cancer after tube removal, potentially delaying treatment if symptoms arise. Concerns also exist regarding the potential for triggering earlier menopause in some women, though this is less common than with ovary removal.
While surgical intervention is currently the most effective method for preventing ovarian cancer, ongoing research aims to improve methods for identifying high-risk women and developing personalized prevention strategies.