Ovarian cancer is a serious gynecologic malignancy, often diagnosed at an advanced stage, which contributes to a high mortality rate. The lack of an effective screening test historically focused prevention on high-risk individuals. Recent scientific discoveries have shifted medical thinking, moving the focus of cancer prevention away from the ovary itself and toward the fallopian tube. This new understanding has led to the exploration of surgical procedures that specifically target the fallopian tubes as a novel way to lower cancer risk for a broader population.
The New Understanding of Ovarian Cancer Origin
The majority of ovarian cancer deaths are caused by High-Grade Serous Carcinoma (HGSC), accounting for 70% to 80% of all fatalities. While it was long believed these aggressive tumors originated directly from the surface epithelium of the ovary, advanced studies now show HGSC often begins elsewhere. The fallopian tube, particularly its fimbriated end nearest the ovary, has been identified as the site of origin for a substantial number of these cancers.
A precursor lesion called Serous Tubal Intraepithelial Carcinoma (STIC) forms in the lining of the fallopian tube. STIC is a non-invasive tumor that carries the genetic alterations—such as TP53 gene mutations—found in HGSC. These precursor lesions can shed malignant cells which implant on the ovary or elsewhere, eventually developing into metastatic ovarian or peritoneal cancer. This suggests that removing the fallopian tubes eliminates the tissue where the most common and aggressive form of the disease starts.
Defining Risk-Reducing Surgery
The surgical approach involves procedures that differ in scope and hormonal impact. Opportunistic Salpingectomy (OS) is the removal of both fallopian tubes while leaving the ovaries intact. The term “opportunistic” refers to the procedure being performed during another already-indicated pelvic surgery, such as a hysterectomy for benign conditions or in place of a standard tubal ligation.
A more extensive procedure is the Bilateral Salpingo-Oophorectomy (BSO), which involves the removal of both the fallopian tubes and the ovaries. BSO is the traditional and most effective procedure for women at high genetic risk, such as those with BRCA mutations. The key difference is that OS preserves ovarian function, while BSO eliminates it, which is a major consideration for premenopausal women.
Quantifying Risk Reduction and Eligibility
Removing the fallopian tubes offers a significant reduction in the risk of developing ovarian cancer. Population-based studies indicate that women who undergo salpingectomy experience a substantial decrease in risk, with some showing a reduction of up to 65% compared to the general population. When performed instead of tubal ligation for sterilization, opportunistic salpingectomy reduces the risk by an estimated 49% overall.
Current medical guidelines support offering opportunistic salpingectomy to average-risk women who are undergoing other pelvic surgeries and have completed childbearing. This includes women having a hysterectomy for non-cancerous reasons or those seeking permanent contraception. The procedure is a preventative measure for the average-risk woman, addressing the origin of HGSC without the health consequences of immediate surgical menopause. For women at high genetic risk, BSO remains the gold standard, offering a risk reduction of 75% to 96%.
Impact on Hormone Production and Menopause
A major advantage of opportunistic salpingectomy is the preservation of ovarian function, which prevents premature menopause. The ovaries are the primary source of estrogen and progesterone, and their removal during a BSO results in immediate surgical menopause. This can lead to hot flashes, mood changes, and long-term health risks like cardiovascular disease and osteoporosis.
The procedure to remove only the fallopian tubes is designed to preserve the blood supply to the ovaries. Studies have shown that salpingectomy alone does not negatively affect ovarian hormone production or ovarian reserve. Therefore, women who undergo this risk-reducing surgery are not subjected to the immediate or accelerated menopausal symptoms.