Surgical Removal of Fallopian Tubes to Prevent Ovarian Cancer Rapidly Rising, More Research Needed to Support Its Continued Use

Despite limited data to support its use, the surgical removal of a woman’s fallopian tubes as a measure to prevent the occurrence of ovarian cancer has been rapidly adopted into clinical practice across the United States, according to study results presented during the 2020 ASCO Virtual Scientific Program.

“Recent evidence indicates that many high-grade serous ovarian cancers originate in the fallopian tubes and involve the ovaries secondarily,” Pritesh S. Karia, a postdoctoral researcher at Columbia University Mailman School of Public Health, said during a pre-recorded presentation of the data. “This has led to the emergence of opportunistic salpingectomy, the surgical removal of the fallopian tubes, as a novel ovarian cancer prevention strategy.”

Some national societies, despite limited data, Karia said, have recently recommended the procedure for the prevention of ovarian cancer to be performed during a benign hysterectomy or in place of tubal ligation in women at average risk for the disease. However, Karia noted that prior to the study, little was known regarding how frequently the procedure was being conducted nationwide.

To assess national trends in the adoption of the surgical removal of fallopian tubes for ovarian cancer prevention between 2010 and 2017 in a sample of 48 million cancer-free women, the study authors examined annual rates of surgery overall and conducted an interrupted time series analysis to assess the effect clinical practice guidelines had on the adoption of salpingectomy. There were 638,596 surgeries performed during the study period.

There was a 42% decrease in the annual rate of tubal ligation — or the surgical procedure of cutting and tying the fallopian tubes off – and a 2,000% increase in the annual rate of salpingectomy for the prevention of pregnancy from 2010 to 2017.

In 2010, salpingectomy accounted for less than 1% of all pregnancy prevention procedures and increased to 21% in 2017.

There was a 76% decrease in the annual rate of hysterectomy — or the removal of a woman’s uterus – and a 660% increase in the annual rate of hysterectomy and salpingectomy during the study period. Salpingectomy accounted for approximately 1% of all benign hysterectomy procedures in 2010 and increased to 32% in 2017.

Most of the women (92%) who received a salpingectomy for the prevention of pregnancy were under the age of 45. A little more than half (56%) of the women who received a hysterectomy with salpingectomy were also under the age of 45.

Most (46%) hysterectomy and salpingectomy procedures were performed in women diagnosed with uterine fibroids. Ten percent of the women who underwent a hysterectomy and salpingectomy had a family history of breast or ovarian cancer.

Data from the interrupted time series analysis demonstrated that there was a 250% increase in age-adjusted quarterly rate of salpingectomy for prevention of pregnancy following the release of a guideline.

There was a 109% increase in the rate of hysterectomy and salpingectomy immediately after the guideline was released.

“Our findings indicate that, despite limited evidence, opportunistic salpingectomy for ovarian cancer prevention has rapidly diffused into clinical practice in the United States,” Karia concluded. “Additional studies evaluating the overall efficacy of salpingectomy are needed to support its continued use.”

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