Should you have your fallopian tubes removed to reduce your ovarian cancer risk?

A woman could have her fallopian tubes removed for many reasons. Sometimes, it’s necessary to treat an ectopic pregnancy or to resolve an infection caused by pelvic inflammatory disease. Other times, it’s done as a permanent form of birth control.

But a growing body of evidence suggests that many cases of high-grade serous ovarian cancer start in the distal fallopian tube — or flower-shaped section located nearest the ovary. High-grade serous is 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 abdominal or pelvic surgery — can help reduce the chances of one day developing ovarian cancer.

So, who should consider having their fallopian tubes removed, and when? And, should you seek out the procedure if you're done having children, even if you’re only at average risk of ovarian cancer? We asked Michaela 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 your fallopian tubes removed is one form of surgical sterilization. It used to be 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 . This is commonly referred to as “having your tubes tied.”

But it’s important to distinguish between these two procedures because they’re very different — and some of the benefits of fallopian tube removal can’t be obtained by simply clipping or blocking the tubes. 

Why is that?

A growing body of data suggests that many ovarian cancers start in the fallopian tubes. So, a lot of surgeons have changed their practice to remove the fallopian tubes entirely to give patients additional protection against it. 

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. 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 having kids. 

Most ovarian cancers are diagnosed at stage 3 or 4, so we don’t usually see it in its earliest stages. But what we noticed when we started performing these surgeries is that in some women, there were precancerous lesions already present in the fallopian tubes. 

This was a really exciting discovery. 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 — either during hysterectomies or instead of patients 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 hasn't gone through menopause yet, her fallopian tubes might still be benefitting her. But once she’s finished having kids, the fallopian tubes serve no real purpose.

So, who should consider having their fallopian tubes removed? 

Only 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. This is called a risk-reducing salpingo-oophorectomy.

Otherwise, it’s currently only recommended as an opportunistic salpingectomy: something to be done when you’re finished with childbearing and are already having another type of procedure, and/or prefer this option for pemanent sterilization.

Which surgical procedures can be combined with an opportunistic salpingectomy?

Initially, doctors only recommended it when you were having another gynecologic procedure done. Today, it can be done alongside almost any kind of surgical procedure that involves the pelvis or abdominal cavity.

Why is this a significant development in the cancer prevention world?

We didn’t typically bundle other types of surgeries with the removal of fallopian tubes at first. That’s because only OB-GYNs were specifically trained in that procedure.  

Now, our gynecologic oncologists routinely team up with other UT MD Anderson surgeons to provide this service. It’s really exciting to see this strategy being implemented to reduce our patients’ risk of ovarian cancer even further.

Are any related clinical trials available?  

We actually have two clinical trials going on right now.

The first trial is for women with certain genetic mutations who are done having kids, but not quite ready to have their ovaries removed. Participants have their fallopian tubes removed now, but delay the removal of their ovaries until later — between ages 35 and 45 for patients with BRCA1, for example, and between ages 40 and 50 for those with BRCA2. The goal is to determine if it’s safe to delay the removal of both ovaries for women at high risk of developing ovarian cancer. This trial is being led by gynecologic oncologist Roni Nitecki Wilke, M.D.

The second trial is for women at average risk of ovarian cancer, who are having an unrelated abdominal surgery, such as an appendectomy, gallbladder removal or hernia repair. Participants watch an educational video about the benefits of doing both procedures at the same time, then complete a questionnaire and decide how they want to move forward. The main goal is to find out if the video improves women’s knowledge and if they would be interested in having this preventive procedure if they learned about it in advance. The study also seeks to understand how to best coordinate these procedures between surgeons and to measure how much additional time will be added to the original procedures. This trial is being led by gynecologic oncologist Larissa Meyer, M.D.

Can anyone get an opportunistic salpingectomy?

You don’t necessarily have to be on a clinical trial to have an opportunistic salpingectomy. Women at average risk of ovarian cancer may also seek out an opportunistic salpingectomy. Talk to your care team for details.

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