Is it worth removing your fallopian tubes if you're not at an obvious risk of ovarian cancer? A top advocacy group recommends it

Ovarian cancer is a relatively rare disease that mainly affects older women. However, it is also a condition that is challenging to diagnose early on. Very often, by the time a person experiences symptoms and doctors diagnose it, the disease has progressed to an advanced stage. This is why a leading ovarian cancer research and advocacy group is recommending a pretty aggressive strategy to prevent the disease: to remove a woman’s fallopian tubes if she’s not planning on having more children, and is undergoing other gynecological surgeries.

The recommendation, which was recently shared by the Ovarian Cancer Research Alliance (OCRA), would apply to women and anyone with ovaries regardless of their ovarian cancer risk. This includes those without a family history of the disease or a genetic predisposition to it.

Women with a strong family history of ovarian cancer, or those who carry gene mutations such as BRCA1 and BRCA2, are at a higher risk for this type of cancer. For many of these patients, doctors already routinely recommend the removal of their fallopian tubes and ovaries once the person has decided not to have more children.

“We think it’s important that you know, anybody with ovaries be aware of this as an option if they are having a pelvic surgery anyway,” Sarah DeFeo, chief program officer for OCRA, told Yahoo News. “You know, we’re not suggesting, and I don’t think anybody is suggesting, that average-risk women go out and have surgeries specifically and only for this purpose. What we’re saying is, if you happen to be having pelvic surgery anyway, and hundreds of thousands of women in the United States every year [do], then you should discuss with your doctor if it makes sense to remove your tubes at the same time,” she added.

The surgery to remove both fallopian tubes is called a bilateral salpingectomy, and it is also a form of permanent birth control for those who do not desire to have more children. During the procedure — which requires general anesthesia — the surgeon locates the fallopian tubes and detaches them from the ovaries and uterus. Patients typically recover within one to three weeks. Those who wish to become parents after fallopian tube removal can do so through in vitro fertilization.

Ovarian cancer is the fifth-leading cause of cancer-related deaths among women in the United States, according to the American Cancer Society. Every year, roughly 19,710 women in the U.S. are diagnosed with the disease, and about 13,000 women die from it.

According to OCRA, “70% of ovarian cancer begins in the fallopian tubes,” so by removing them, a woman could significantly reduce her chances of developing the disease.

Although it isn’t clear how many people will be affected by OCRA’s recommendation, millions of American women could be candidates for the risk-reducing procedure. About 4 million gynecologic surgeries are performed in the U.S. every year, according to a Washington Post report. These include tubal ligations, surgeries to remove uterine fibroids and ovarian cysts, as well as hysterectomies, which are surgical procedures to remove a woman’s uterus.

In addition to encouraging women to consider fallopian removal surgery as a way to reduce their ovarian cancer risk, OCRA said it was also beginning a nationwide push to make genetic testing more readily available for women to learn about their risks. According to the organization, “20% of ovarian cancers are caused by a genetic mutation.” Unfortunately, many people without a clear family history of ovarian cancer may not necessarily be aware that they carry these mutations. Genetic testing can also be expensive, which explains why regular screening tests are not more widely used.

Although not everyone with gene mutations will develop this type of cancer, experts have said knowing a person’s risk could save lives. In order to increase risk awareness, OCRA launched a pilot program that offers free, at-home genetic testing for those at increased risk.

Why is OCRA making the recommendation now?

In a press release shared with Yahoo News, OCRA said it was dramatically shifting its decades-long focus in the fight against ovarian cancer from symptom awareness and early detection to prevention.

The new strategy comes after the results of a “rigorous” clinical trial in the United Kingdom that followed more than 200,000 women for over 20 years showed “that current screening methods do not impact mortality in average-risk women,” OCRA said.

“We know because of that study that there is no way to screen for ovarian cancer with currently available methods that work, that saves lives, so we can’t rely on screening,” DeFeo said, adding that relying on symptoms is also ineffective.

Dr. Jeannine Villella, chief of gynecologic oncology at Lenox Hill Hospital in New York, said the challenge with diagnosing ovarian cancer is that symptoms of ovarian cancer often mimic normal symptoms of menopause. This can include an increase in urination and abdominal weight gain.

“Sometimes they have painful intercourse, and these are very general [symptoms]. They might have [a] change in bowel habits, which, you know, now in the age of gluten sensitivity and other sensitivities to foods, this is very common,” Villella said, adding that for these reasons women are often not seen by a gynecologist until is too late. “So the first thought is not that someone has cancer, it’s that they might have one of those other disorders.”

DeFeo said this is one of the reasons her organization decided to switch its messaging.

“At OCRA we said, you know, we need to focus on a message to the public that we know will really make a difference, and that means focusing on understanding your risk factors, and if you can, and if it makes sense, to take action to reduce your risk,” she said.

Not all experts are backing OCRA’s recommendation

The guidance to remove fallopian tubes in order to prevent ovarian cancer is not entirely new, DeFeo said. The American College of Obstetricians and Gynecologists has recommended the procedure, also known as “opportunistic salpingectomy,” in cases where it’s appropriate, since 2015. It reaffirmed this recommendation in 2020, though it noted that although the procedure “offers the opportunity to significantly decrease the risk of ovarian cancer, it does not eliminate the risk of ovarian cancer entirely.”

Following OCRA’s statement, the Society of Gynecologic Oncology also endorsed the strategy.

Villella told Yahoo News she was surprised by OCRA’s guidance because at this point, she doesn’t believe there is enough evidence to make a definitive recommendation for the procedure for the average-risk woman.

“I think if you look at the possibilities of the pathogenesis of developing ovarian cancer, one can be that ovarian cancer can start in the tube. But I don’t know at this point if we are certain that by removing fallopian tubes, it will definitely decrease the risk of ovarian cancer,” Villella said, adding that the procedure was still considered “experimental.”

DeFeo acknowledged that the procedure was still being researched in order to fully understand all of the implications of the surgery for ovarian cancer prevention, but she said that the practice is increasingly being used, and professional societies have embraced this approach as well.

In addition, a representative from OCRA noted that a recent study of more than 25,000 participants has shown how opportunistic salpingectomy can make a difference in reducing a woman’s chances of developing the disease.

“It’s just not something that we feel has really gotten sufficient attention, given how potentially impactful this can be in terms of ovarian cancer prevention,” DeFeo said.

Updated, Sat., Feb. 18, 2023 at 1:45 p.m. ET. This story has been updated to reflect a counter-response from OCRA.