All women, regardless of their risk profile, should consider prophylactic removal of the fallopian tubes at the same time as other pelvic surgery once they are finished having children, the Ovarian Cancer Research Alliance (OCRA) has advised.
The recommendation, announced February 1, replaces the decades old focus on symptom awareness and early detection and follows "sobering and deeply disappointing" results from a large UK study published 2 years ago, the organization said.
That was the UK Collaborative Trial of Ovarian Cancer Screening published in The Lancet in May 2021, which followed more than 200,000 women for a median 16 years. It showed that screening average-risk women with a CA-125 blood test and ultrasound does not reduce deaths from the disease, as reported at the time by Medscape Medical News.
"We all hoped that the trial would show that early detection was effective in changing mortality rates. When the results came out, it was very hard to accept," Audra Moran, OCRA president and CEO, told Medscape Medical News.
"We have an obligation to let people know that symptom awareness and early detection will not save lives" but considering opportunistic salpingectomy "absolutely will," said Moran. Hence the renewed call for women to consider having their fallopian tubes removed.
What sounds new about this call is that the group is directing fallopian tube removal to all women "who are undergoing pelvic surgeries for benign conditions," irrespective of what perceived risk they have of developing ovarian cancer (for example, based on family history).
But this advice has been in place for years for women who are known to be at higher risk for the disease.
For instance, women at high risk for ovarian cancer based on Hereditary Breast and Ovarian Cancer Syndrome (HBOC) have long been recommended to undergo surgery to remove ovaries and fallopian tubes (risk-reducing bilateral salpingo-oophorectomy or RRBSO) once there is no longer a desire for pregnancy.
Approached for comment about the new messaging, Stephanie V. Blank, MD, president of the Society of Gynecologic Oncology (SGO), says that the new recommendation — that all women who are finished childbearing consider opportunistic salpingectomy at the time of other pelvic surgery for benign conditions — is "not aggressive."
"It's reasonable and makes sense," Blank told Medscape Medical News.
And she pointed out that it's actually not "new"; it is, however, getting "new attention" based on the disappointing UK screening study, said Blank, director of gynecologic oncology for the Mount Sinai Health System in New York City and professor of gynecologic oncology at Icahn School of Medicine at Mount Sinai.
She noted that the procedure of opportunistic salpingectomy has been endorsed by SGO since 2013 and by the American College of Obstetricians and Gynecologists (ACOG) since 2015.
There is increasing evidence that most high-grade serous ovarian cancers arise from cells in the fallopian tubes, William Dahut, MD, chief scientific officer for the American Cancer Society (ACS), told Medscape Medical News.
"Indirect evidence suggests a fairly strong degree of risk reduction associated with opportunistic salpingectomy for the most prevalent type of ovarian cancer (serous), and some risk reduction of epithelial ovarian cancer. At this time, these discussions seem warranted," Dahut said.
At this point, however, the fact that leading organizations advise "consideration" means that the evidence base has "not been judged to be sufficiently strong (in terms of what we can say about benefits and harms) to advise a direct recommendation for opportunistic salpingectomy," Dahut added.
There is no current recommendation to have fallopian tubes removed as a stand-alone procedure, he pointed out. However, he commented that "the occasion of scheduled gynecologic surgery presents an opportunity to possibly reduce the risk of ovarian cancer without known adverse effects in women who have completed childbearing. Having the discussion seems to be justified by the current evidence," Dahut said.
Deanna Gerber, MD, gynecologic oncologist at NYU Langone Perlmutter Cancer Center-Long Island, agrees. "In women who are scheduled to have a gynecologic or pelvic procedure, clinicians should discuss the possibility of removing the fallopian tubes at that time. A salpingectomy is a relatively low-risk procedure and adds little time to the surgery," Gerber told Medscape Medical News.
"Women should understand that there is still ongoing research on this topic, but this low-risk procedure may reduce their risk of developing an ovarian or fallopian tube cancer," Gerber said.
OCRA also encourages all women (or anyone born with ovaries) to know their risk for ovarian cancer. To that end, the organization has launched a pilot program offering free, at-home genetic testing kits to people with a personal or family history of breast, ovarian, uterine, or colorectal cancer.
Moran, Blank, Dahut, and Gerber report no relevant financial relationships.
Ovarian Cancer Research Alliance. Consensus Statement
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Cite this: Renewed Calls for Fallopian Tube Removal to Avoid Ovarian Cancer - Medscape - Feb 07, 2023.