Fallopian tube removal advised for more to help prevent cancer

To prevent more cases of ovarian cancer, a major research and advocacy group is suggesting an aggressive prevention strategy: remove a woman’s fallopian tubes if she is undergoing pelvic surgery for another reason.

The practice would apply to women, trans men or nonbinary people at average risk who don’t plan to have any or additional children. The fallopian tubes are hollow structures that allow eggs to travel from the ovaries to the uterus.

The guidance to remove them, included in a new consensus statement from the Ovarian Cancer Research Alliance, is not entirely new – it reflects conversations many doctors already have with their patients and mirrors guidelines from at least two medical groups.

But the advice is certain to draw increased attention to fallopian tube removal as a way to lower ovarian cancer risk.

“I can guarantee you these conversations happen,” said Arif Kamal, chief patient officer for the American Cancer Society. “This is now an important group that has come out and said ‘We really do think these conversations should happen pretty regularly.’”

Here are answers to questions about the recommendations.

Where does this new advice come from?

The Ovarian Cancer Research Alliance, a leading cancer research group, recently posted a consensus statement encouraging patients to consider preventive fallopian tube removal if they are undergoing pelvic surgery for another noncancerous condition including hysterectomy, tubal ligations, cysts and endometriosis.

The group notes that because “the fallopian tube is the origin of most highgrade serous cancers, fallopian tube removal has been shown to dramatically reduce risk for a later ovarian cancer diagnosis.”

The group’s recommendations, first reported in The New York Times, also encourage women and anyone born with ovaries to learn more about their genetic risk for ovarian cancer. Those who have BRCA1 and BRCA2 cancer genes or a strong family history of ovarian cancer are routinely advised to have fallopian tubes and ovaries removed after childbearing is complete or not planned.

Why is fallopian tube removal for more women being recommended?

Efforts to identify a screening test for ovarian cancer have failed. A large British clinical trial used scans and blood tests hoping to find ovarian cancer at an early stage, but the results showed the screening tests didn’t reduce deaths from the disease.

Should I have my tubes removed even if I’m not planning another surgery?

Nobody is recommending the procedure for people at average risk if no other surgery is planned.

How many people are affected by this advice?

It’s unclear exactly how many women, trans or nonbinary patients would be candidates for fallopian tube removal. But about 4 million gynecologic surgeries are performed each year in the United States, including about 600,000 hysterectomies, which is surgical removal of the uterus, as well as tubal ligations, removal of fibroids or cysts and other procedures.

What happens during surgery for fallopian tube removal?

Surgical removal of the fallopian tubes is called a bilateral salpingectomy, and it’s also a permanent form of birth control because the egg can no longer reach the uterus. Recovery typically takes one to three weeks and the procedure typically requires general anesthesia, according to Johns Hopkins. But recovery could take longer depending on what other surgery is performed at the same time.

Will I still have periods after fallopian tube removal?

The fallopian tubes aren’t involved in menstruation, so you’ll continue to have periods after salpingectomy, reports the Cleveland Clinic.

Should ovaries be removed during surgery?

Ovary removal, called oophorectomy, is discouraged unless a person has a known cancer gene or a strong family history of ovarian cancer, or another condition that might warrant the surgery.

Even after childbearing is over, ovaries continue to serve important functions, supplying women with needed hormones that protect them from heart attacks and thinning bones and influence the sex drive. And removal of the ovaries in younger women will result in an abrupt surge into menopause.

The risk of developing ovarian cancer for most women is relatively low.