Should you have your fallopian tubes removed to reduce your ovarian cancer risk?
A woman could have her fallopian tubes removed for any number of reasons. Sometimes, it’s necessary to treat an ectopic pregnancy or to resolve an infection caused by pelvic inflammatory disease. In other cases, it’s done as a form of permanent birth control.
But a growing body of evidence suggests that the distal fallopian tube — or flower-shaped section located nearest the ovary — is the site of many cases of high-grade serous ovarian cancer, the most common type of ovarian cancer and one of the most aggressive.
Research also suggests that an opportunistic salpingectomy — the complete removal of the fallopian tubes during an unrelated pelvic surgery — could help reduce the chances of one day developing ovarian cancer.
So, who should consider having their fallopian tubes removed, and when? And, should anyone who’s finished childbearing seek out the procedure, even if they’re only at average risk of ovarian cancer? We asked Michaela Onstad-Grinsfelder, M.D., a surgeon specializing in gynecologic cancers.
Why do women typically have their fallopian tubes removed?
Women don’t usually go in just to have their fallopian tubes removed unless it’s for permanent birth control or to treat an ectopic pregnancy.
Having the fallopian tubes removed is one form of surgical sterilization, or “having your tubes tied.” Until fairly recently, it was more common for surgeons to use a metal clip or a ring to constrict and physically block the tubes, rather than removing the structures themselves.
Why has that changed?
A growing body of data suggests that the fallopian tubes may be the origin of many ovarian cancers. So, a lot of surgeons have changed their practice to remove the fallopian tubes entirely to give patients additional protection against ovarian cancer.
In the United States, the Society for Gynecologic Oncology and the American College of Obstetricians and Gynecologists both support the removal of fallopian tubes as permanent sterilization for women at average risk for ovarian cancer, but it’s also recommended by professional organizations in Australia, Canada, Germany and New Zealand.
How was this information discovered?
After the BRCA gene was linked to an increased risk for breast and ovarian cancers, doctors started removing the ovaries and fallopian tubes as a type of risk-reduction surgery, once BRCA-positive women were finished with childbearing.
Most ovarian cancers are diagnosed at stage III or IV, so we don’t usually see the disease in its earliest stages. But what we noticed when we started performing these surgeries is that there were often pre-cancerous lesions present in the fallopian tubes.
This was a really exciting discovery because, before that, we hadn’t known there was a lesion that could one day become ovarian cancer. So, we were able to start finding ovarian cancers really early that we hadn’t been able to catch before.
How did that discovery lead to the recommendation of opportunistic salpingectomies?
There was a lot of excitement in the medical community at that point about the possibility of reducing the risk of ovarian cancer by removing the fallopian tubes during hysterectomies or when patients were having their “tubes tied.” Before that, whenever someone had a hysterectomy, we would normally only take out their fallopian tubes if we were also taking out their ovaries.
But as the new data emerged, there was an increased interest in removing the fallopian tubes along with the uterus when performing hysterectomies. Because if a woman is pre-menopausal, her ovaries might still be benefitting her. But once she’s finished childbearing, the fallopian tubes serve no real purpose.
So, who should consider having their fallopian tubes removed?
People who are at increased risk of developing ovarian cancer, such as those who carry the BRCA genetic mutation, are recommended to have a stand-alone surgery to remove fallopian tubes with both ovaries (called a risk-reducing salpingo-oophorectomy).
Otherwise, it’s only recommended as an opportunistic salpingectomy: something to be done when you’re already having another type of gynecologic procedure, such as a hysterectomy.
Are any related clinical trials available?
We have a clinical trial going on right now for BRCA-positive women who are done with childbearing but are not quite ready to have their ovaries removed.
In this clinical trial, participants will have their fallopian tubes removed now, but delay the removal of their ovaries until later (between the ages of 35 and 45 for patients with BRCA1 and between the ages of 40 and 50 for those with BRCA2). The goal is to determine if it may be safe to delay the removal of both ovaries for women at high risk of developing ovarian cancer.
Do you ever foresee a time in which an opportunistic salpingectomy could be combined with another procedure, such as an appendectomy or a hernia repair?
Right now, we don’t typically bundle other types of surgeries with the removal of fallopian tubes. That’s partially because only OB-GYNs are specifically trained in that procedure.
But we’re actively looking for ways to team up with other surgeons to offer this service together. It could be an exciting strategy in the future to further reduce patients’ risk of ovarian cancer.