Salpingectomy May Prevent Ovarian Cancer, ACOG Says

Veronica Hackethal, MD

December 31, 2014

Removal of the fallopian tubes may help prevent ovarian cancer, according to an opinion written by the American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice. The opinion appears in the January 2015 issue of Obstetrics & Gynecology.

"Salpingectomy at the time of hysterectomy or as a means of tubal sterilization appears to be safe, without an increase in complications...compared with hysterectomy alone or tubal ligation," the committee writes.

"Counseling women who are undergoing routine pelvic surgery about the risks and benefits of salpingectomy should include an informed consent discussion about the role of oophorectomy and bilateral salpingo-oophorectomy."

The opinion specifically addresses women at "population risk" for ovarian cancer, meaning women who do not have an elevated genetic risk for ovarian cancer but who are having routine pelvic surgery for benign disease.

Among gynecologic cancers, ovarian cancer carries the highest mortality rate; it ranks as the fifth leading cause of death from cancer in women, the authors note. The survival rate for ovarian cancer has not improved much during the last 50 years.

The committee made the following recommendations:

  • In women at population risk for ovarian cancer, surgeons should discuss the potential benefits of salpingectomy.

  • In women considering laparoscopic sterilization, physicians can discuss the fact that bilateral salpingectomy provides effective contraception, while pointing out that this procedure eliminates the option of tubal reversal.

  • Prophylactic salpingectomy may prevent ovarian cancer in some patients.

  • More randomized controlled trials are needed to support the use of salpingectomy in reducing ovarian cancer.

The committee urges surgeons to continue to use minimally invasive techniques. For now, the possible benefit of salpingectomy should not sway decisions about which technique to use for hysterectomy and sterilization. For example, the committee advises surgeons not to switch from vaginal to laparoscopic hysterectomy simply to do a salpingectomy.

The committee cited various studies to back up its opinion. About 75% of ovarian cancers and 90% of deaths from ovarian cancer result from epithelial ovarian cancer, they write. In contrast to traditional views that epithelial ovarian cancer arises from elements of the ovaries, recent research suggests that epithelial ovarian cancer derives from elements of the fallopian tube and endometrium.

Research has also pointed to a protective effect of tubal ligation against endometrioid and clear cell carcinomas, suggesting these tumors may arise from retrograde menses.

On the basis of current views about ovarian carcinogenesis, the committee continues, salpingectomy while leaving the ovaries intact may be better for cancer prevention than oophorectomy and bilateral salpingo-oophorectomy. The latter techniques can cause early menopause and increased risk for cardiovascular disease, osteoporosis, and cognitive impairment and were also linked to increased risk for all-cause and cancer specific mortality in the Nurses' Health Study.

Obstet Gynecol. 2015;125:279-281. Full text

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