Ovarian Cancer Prevention: Should You Consider Having Your Fallopian Tubes Removed?

Ovarian Cancer Prevention: Should You Consider Having Your Fallopian Tubes Removed?

Women who undergo routine pelvic surgeries should also consider having their fallopian tubes removed to prevent ovarian cancer, the Ovarian Cancer Research Alliance said last week. Although the recommendation is not mandatory or necessary, experts hope it will spur more conversations between patients and their doctors about the procedure's potential benefits.

In the absence of high-quality screening options for ovarian cancer, a leading advocacy and research organization is calling for more women or people born with ovaries to consider having their fallopian tubes removed, regardless of genetic risk status, to avoid ovarian cancer.

The recommendation, released in a statement last week, comes from the Ovarian Cancer Research Alliance. It encourages removal of fallopian tubes during other pelvic surgeries for benign conditions — such as hysterectomies, tubal ligatures, cysts and endometriosis — as long as women are finished bearing children.

"Once women are done giving birth, the [fallopian] tubes don't do much," said Susan Modesitt, MD, director of gynecologic oncology at Emory University's Winship Cancer InstituteHealth. “[We can] take these out sooner without really having any adverse effects.”

Despite its name, most ovarian cancers – and the most aggressive type of ovarian cancer tumors – arise in the fallopian tubes. Because fallopian tubes are not necessarily beneficial after birth, removing them can significantly reduce the risk of developing ovarian cancer, the deadliest gynecological cancer, explained Dr. fashion custom.

In addition to recommending this preventive surgery, the OCRA also encouraged health care providers to learn more about the symptoms of ovarian cancer so that patients can receive quicker diagnoses and to promote genetic testing so that people are more aware of their risk, among other things.

Here's what experts had to say about the OCRA recommendation, why it's the best option available to prevent ovarian cancer, and how healthcare might look different for patients in the future.

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Expansion of an existing prevention method

Although the recommendation is new, the idea of ​​removing fallopian tubes to reduce the risk of cancer is not new.

Just as people may have an increased risk of breast cancer if they have certain genetic mutations, certain people may also have an increased risk of developing ovarian cancer if they have mutations in the BRCA1 and BRCA2 genes.

For this group, doctors have recommended salpingectomies — or surgeries to remove the fallopian tubes — and surgeries to remove the ovaries for more than two decades, said Oliver Dorigo, MD, PhD, director of the division of gynecologic oncology at Stanford University. The researchers found that some of these patients had very early-stage cancer that started in the fallopian tubes rather than the ovaries.

When the surgery to prevent ovarian cancer is performed at the same time as another pelvic surgery, it is called an opportunistic salpingectomy.

"That [insight] led to the idea that removing the fallopian tube could actually prevent ovarian cancer - not just in patients with genetic mutations, but also in the general population," said Dr. DorigoHealth.

Back in 2013, the Society of Gynecologic Oncology—which also supported the OCRA's recent statement—recommended that women in the general population should consider having their fallopian tubes removed if they undergo a hysterectomy, a procedure to remove the uterus, or other pelvic surgeries, such as: B. tying the fallopian tubes.

But after the publication of a 2021 study that found that early detection of ovarian cancer and symptom awareness had no impact on saving women's lives, the discussion about tube removal as an effective prevention tool was reignited. The findings prompted OCRA to issue its recommendation.

“Symptoms campaigns that target people saying, ‘Knowing the symptoms will save your life,’ just [aren’t] true,” said Audra Moran, president and CEO of OCRAHealth. “We wanted people to focus their efforts on something that could actually make a difference and save lives.”

Overview of Ovarian Cancer

Why doesn't less invasive prevention work?

It is not uncommon for cancer screening to be part of normal health care for the general population, be it a colonoscopy, Pap smear, or mammogram to screen for early signs of colon cancer, cervical cancer, and breast cancer, respectively. And while some tests have been used to screen for ovarian cancer — doctors may do a pelvic exam, a transvaginal ultrasound or a CA-125 test — they don't actually help reduce ovarian cancer deaths, Dr. fashion custom.

There are currently no screening tests recommended for women at average risk or for women without symptoms.

“They pick up benign things that would never become cancerous, and people have to undergo unnecessary surgery,” she said. “And even if you occasionally pick [the cancer] at an earlier stage, there is no improvement in survival or outcomes.”

In the 2021 study, the OCRA based its recommendation in part on the fact that even women whose cancer was diagnosed at stage 1 or 2 did not see specific benefits in cancer mortality — despite the fact that researchers estimated they were diagnosed an average of 18 months before their symptoms would have started.

However, in the same study, some women diagnosed with later-stage ovarian cancer did “very well” and were not necessarily condemned to a worse prognosis. Researchers say this likely has something to do with how aggressive or not their cancer was - regardless of staging.

The reality of ovarian cancer is that it is not as easy as other cancers. It is “highly heterogeneous,” meaning the term “ovarian cancer” can refer to many unique types of cancer. According to OCRA, this may explain why some late-stage patients may go into remission and be cured, and some early-stage patients may die from the disease.

Ovarian cancer also grows differently than other solid tumors: It typically begins as tiny cancer cells in the fallopian tubes. Instead of growing into a solid tumor and then spreading throughout the body, these tiny cancer cells first spread throughout the abdomen before then growing to a size that doctors can detect during a test or screening, Dr. Fashion custom added.

The symptoms of ovarian cancer - which can include bloating, pelvic pain, fatigue and urinary urgency - are also non-specific, meaning they can be attributed to a number of other conditions. Women are also more likely to have these symptoms when the disease has spread and gone beyond the early stages.

According to OCRA, "People diagnosed with ovarian cancer and their families should be relieved of the burden of believing that if they had only recognized and responded to the symptoms sooner, they would have a completely different outcome, because we know this is not the case."

Based on these facts, for now, experts believe that the best way to prevent ovarian cancer is to go straight to the source and remove fallopian tubes if a person no longer needs them to bear a child in the future.

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A small procedure with a big benefit

While this is certainly a more invasive preventative procedure than some others, the recommendation may not have a major impact on how people with fallopian tubes experience healthcare in the future.

First, the recommendation only applies to women in the general population who have already undergone pelvic surgery. Women who are at high risk of ovarian cancer may be able to have their fallopian tubes and ovaries removed as early as age 35, Dr. Dorigo. But for people at average risk, the surgery can only be performed if it is added to another pelvic surgery.

And this additional surgery to get the fallopian tubes out can generally be pretty easy. Salpingectomy can take as little as five to 10 minutes when added to another procedure, Dr. fashion custom.

And unlike ovaries, which produce hormones and prevent heart disease and cancer, among other things, a person likely won't notice any changes at all after having their fallopian tubes removed.

“The fallopian tubes don’t produce hormones,” said Dr. Dorigo. “Patients who have had their fallopian tubes removed should not experience any functional deficits.”

And the process seems to be working. A 2022 study found that a group of women who underwent surgery to remove their fallopian tubes had no severe cases of ovarian cancer.

Of course, fallopian tube surgery is not without possible complications. As with any surgery, there is always the possibility of a problem with bleeding or infection, experts agreed. And of course, the procedure isn't a complete guarantee that a person will never get ovarian cancer, Dr. Fashion custom added.

But for people with fallopian tubes, care to prevent ovarian cancer only changes if they want it to. The OCRA statement is non-binding.

"It's not like, 'You should definitely do this or you'll get ovarian cancer.' That sounds scary. And that's not true," Moran said. "But again, if this is something you can do that doesn't make a difference to you, your health, your body, it doesn't change anything about you as a person and you've already had the surgery, then at least talk about it."

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Opening the conversation

More than anything, the OCRA statement is intended to remind both physicians and their patients to be aware of the benefits of this preventive procedure and to spend some time discussing whether it might be a good option.

An estimated 600,000 hysterectomies are performed in the United States each year, which does not include the number of other pelvic surgeries that people with fallopian tubes may receive. So if this were to become more widespread, explained Sarah DeFeo, OCRA's chief program officer, it could have a big impact on ovarian cancer rates.

“These are surgeries that these women are going to have anyway, so there seems to be a lot of upside and not a lot of downside,” DeFeo saidHealth. "This is actually something the average woman can do to prevent a really deadly cancer. Even though it's not very common, it's very deadly. So that's a huge opportunity."

In addition to having their fallopian tubes removed, people may also consider talking to their doctors about other ways to manage ovarian cancer. This may include using contraceptives that reduce the risk of ovarian cancer.

The OCRA statement also included recommendations that people with fallopian tubes seek genetic testing to determine whether or not they are at increased risk, learn more about ovarian cancer symptoms, and consider participating in clinical trials to increase knowledge of the disease.

“Ovarian cancer is currently detected at very late stages when cure rates are low,” said Karen Lu, MD, chair and professor of gynecologic oncology and reproductive medicine at The University of Texas MD Anderson Cancer CenterHealth. “And if a woman has the opportunity to prevent the disease, we want to make sure she is empowered to have that conversation with her doctor.”