[2023-02-19] Elective removal of fallopian tubes

A friend (and fellow ovarian cancer thriver) recently sent me a CBC article about elective removal of fallopian tubes to reduce the risk of ovarian cancer.

Writing in What experts say you should know about ovarian cancer, reporter Stephanie Dubois says:

Early research has shown an opportunistic salpingectomy—the removal of the fallopian tubes as an elective procedure—can help reduce the risk of ovarian cancer.

Last week, the global nonprofit Ovarian Cancer Research Alliance released a statement encouraging women of average risk to have their fallopian tubes removed after they are done with childbirth and when they have a pelvic surgery for another health issue planned.

Quoting Dr. Gillian Hanley, an assistant professor in the University of British Columbia's obstetrics and gynecology department, Dubois notes that the most common type of ovarian cancer is high-grade serous carcinoma (which is what I had), representing 70% of ovarian cancer cases and 90% of ovarian cancer deaths. She adds that this type of cancer originates primarily in the fallopian tubes (which is where my cancer started) and not on the ovarian surface.

Hanley tells Dubois that fallopian tubes play no known role after child-bearing, so for women who have finished having children, there's no need to keep tissue that could become malignant. Furthermore, the procedure has "no known pitfalls" and adds only about 10 minutes of surgery when done as part of another gynecological surgery (such as a C-section or surgery for endometriosis), which is currently the only way to access the surgery in Canada. What's more, research by Hanley and colleagues shows that elective surgery to remove fallopian tubes lowers the number of ovarian cancers. Dubois writes:

What they found was the nearly 26,000 individuals who underwent opportunistic salpingectomy had significantly fewer serous and epithelial ovarian cancers than were expected compared to the rate among the control group who had either only a hysterectomy or tubal ligation.

When they looked at high-grade serous cancers in particular, there wasn't a single case found among those who had their fallopian tubes removed.

"You don't get better than zero," Hanley said.

Dubois adds this recommendation from Alicia Tone, scientific advisor for Ovarian Cancer Canada:

So if you're at average risk for ovarian cancer—which would be most women—it's recommended that you speak with your health-care provider about removing your fallopian tubes if you're already planning gynecological surgery and are done with having kids.

For people at higher risk for ovarian cancer, such as those with a BRCA gene mutation (which I have), Tone recommends that they have both their ovaries and fallopian tubes removed. Had I known that I had a mutation in my BRCA2 gene, I would have opted for surgery to remove my ovaries and fallopian tubes. Instead, I developed high-grade serous carcinoma, and the mutation was found in the tumours that were removed during surgery. Subsequent genetic testing confirmed that I had inherited the gene mutation, which opened up genetic testing for my blood relatives. That said, as Dubois points out in her article, only about 20% of ovarian cancers are linked to inherited gene mutations. The majority of ovarian cancer cases are in people with no known genetic mutations.

But for people without risk factors that raise their chance of developing ovarian cancer—such as a BRCA gene mutation, a family history of certain cancers, or endometriosis—an opportunistic salpingectomy performed as part of a planned gynecological surgery is recommended and, according to the article, has been happening in Canada for more than a decade.

A statement by the Ovarian Cancer Research Alliance (which Dubois links to in her article) encourages people with ovaries to:
  • know their risks,
  • avail themselves of genetic testing if it is offered,
  • consider having their fallopian tubes removed if undergoing pelvic surgeries for benign conditions (such as hysterectomy, tubal ligations, cysts, endometriosis), and
  • know the signs and symptoms of ovarian cancer so that they can receive a prompt diagnosis and treatment.
The Alliance also recommends that family members of people found to have a gene mutation that increases their risk for ovarian cancer get genetic testing as well.