Can removing fallopian tubes really reduce the risk of ovarian cancer?

Ovarian cancer poses a significant threat to women, with a five-year survival rate of just over 50%. The disease is challenging to detect early, often diagnosed when it has already progressed. Some are turning to preventive measures, such as the salpingectomy – the removal of fallopian tubes.

High-risk women, such as those carrying the BRCA1 or BRCA2 genes, face a much higher chance of developing ovarian cancer. While a salpingo-oophorectomy (removal of both ovaries and fallopian tubes) can reduce this risk dramatically, it can also lead to early menopause and other adverse side effects.

Interestingly, research has shown that most ovarian cancers actually begin in the fallopian tubes, not the ovaries. A study by Dutch researcher Jurgen Piek in the 1990s found that most ovaries of women with the BRCA1 gene, who had undergone the procedure, showed no signs of cancer. Instead, cancerous cells were found in the fallopian tubes.

Several studies have examined the potential benefits of fallopian tube removal. A 2015 study of over 5 million Swedish women found those who had their fallopian tubes removed had a roughly 60% lower risk of developing ovarian cancer. More recently, a 2023 review suggested the risk could be reduced by up to 80%, although this figure is based more on modelling than clinical studies. Current evidence indicates a 50% reduced risk through clinical studies.

While the procedure is not routinely performed in Australia, many international gynaecological and cancer organizations now recommend it as an option for women undergoing other abdominal or pelvic surgeries, particularly those at high risk due to genetic factors. The Royal Australian and New Zealand College of Obstetrics and Gynaecology also endorses salpingectomy as an alternative to traditional tubal ligation or hysterectomy.

However, the procedure is not yet widely covered by Medicare in Australia, and additional training may be needed for non-gynaecological surgeons to incorporate it into their practice. More long-term studies are needed to confirm these findings and establish the exact benefits and risks.