Does removing the fallopian tubes reduce ovarian cancer?

Ovarian cancer is a formidable foe for women.  Usually by the time it is found, it is already at an advanced stage.  Part of the problem is the symptoms associated with it are common making it much harder to catch early on when it is more treatable.  Some of ovarian cancer’s main symptoms include bloating, gas, constipation, loss of appetite, feeling full quickly, urgency to urinate, pressure in the pelvic area, and vaginal discharge.

Facts on ovarian cancer

A little known fact many women may not realize is that removal of the fallopian tubes significantly reduces rates of ovarian cancer.  While ovarian cancer is not the most common gynecologic cancer (endometrial cancer is number one), it the most lethal gynecologic cancer.  According to the American Cancer Society, 14,070 women are estimated to die from ovarian cancer in 2018.  More than 60% of ovarian cancers are not diagnosed until the disease has metastasized, and the 5-year overall survival rate of patients with metastatic ovarian cancer is less than 50%.

In recent years, researchers have found that many cases of ovarian cancer do not actually begin in the ovaries.  Because of this discovery, it is believed that removing the fallopian tubes could be one way to prevent ovarian cancer before it starts.  The procedure to remove the fallopian tubes is called a salpingectomy.  It is known that ovarian cancers that originate in the fallopian tubes are the most aggressive and deadly.  It would make sense that by removing the fallopian tubes, it could be a promising method of saving lives.

Research showing benefits of fallopian tube removal

More and more research is supporting the potential benefit of ovarian cancer protection by removing the tubes.  One such study included a 2017 meta-analysis published in The Journal of Minimally Invasive Gynecology, which looked at six original medical studies and three meta-analyses published since 2010.  It showed that removing both fallopian tubes may reduce the risk of ovarian cancer by 42% to 78%.   Another 2016 meta-analysis in the European Journal of Cancer found that removing both tubes at the time of a hysterectomy cut a woman’s lifetime risk of ovarian cancer by half. 

Over the years, the procedure to remove the fallopian tubes has grown increasingly more common.  In 2008, only about one in 250 sterilization procedures (tubal ligation) involved removing the fallopian tubes instead of clipping, blocking, or burning them using an electric current.  By 2011, one in three sterilization procedures were salpingectomies. 

Making the decision

Does this mean every woman should eventually have her fallopian tubes removed?  It depends upon several conditions which include the following:

·      Women who are already planning a hysterectomy but do not want their ovaries removed.  Delaying ovary removal can prevent premature menopause and other health risks.

·      Women desiring permanent sterilization.  Removing the tubes provides the same contraceptive effect as tubal ligation, while potentially decreasing ovarian cancer risk.

·      Women who are at increased risk for ovarian cancer and are going to have any abdominal or pelvic surgery. 

·      Women with a strong family history of the disease.

The advantage of fallopian tube removal may offer some protection for preventing ovarian cancer for some women without posing a significant health risk. Like stated earlier, ovarian cancer that begins in the fallopian tubes is the most lethal but other types of ovarian cancer might not.  Therefore, it is not known with certainty, what percentages of ovarian cancer actually start in the tubes making it hard to predict how many cancers can be prevented by removing them.

The belief is that by removing the tubes, this can at least significantly lower the risk of that particular type of ovarian cancer at least for women who are at the highest risk for high-grade ovarian cancer. 

What about tubal ligation?

If a woman is hesitant to remove her fallopian tubes, she may want to consider tubal ligation.  Tubal ligations surgeries have been performed for decades to prevent pregnancy in women.  This permanent form of sterilization is ideal for any woman who is confident she is done having babies and doesn’t want the inconvenience of taking a daily pill or using other birth control.  The surgery takes about 30 minutes and most women are able to go home the same day of the surgery.

According to numerous studies, tubal ligation surgery or having your “tubes tied,” prevents more than just pregnancy.  Years of research shows that tubal ligation may reduce a woman’s risk of developing ovarian cancer by up to 50% in women who have the surgery before the age of 35.

Bottom line

The question of whether a woman should remove her fallopian tubes in order to reduce her risk for developing ovarian cancer is a personal decision.  All women should discuss this with their doctor, weighing the odds of her risk of the disease.

Depending upon the possible long-term consequences and what risk factors a woman has, will usually offer the best direction to take when making this decision.  With any surgery, there are always pros and cons to consider including the surgery of salpingectomy.  Each doctor needs to tailor their approach for each woman seeking their advice for the best plan of care and best outcome.