Risk Reduction of High-Grade Serous Ovarian Cancer with Total Salpingectomy
Total salpingectomy alone (without oophorectomy) may reduce ovarian cancer risk by approximately 42-65% in average-risk women, but this procedure is NOT recommended as standard care for high-risk populations such as BRCA mutation carriers, where bilateral salpingo-oophorectomy remains the gold standard with 80-90% risk reduction. 1, 2, 3
Evidence for Risk Reduction in Average-Risk Women
The magnitude of risk reduction from salpingectomy alone varies based on population risk:
Meta-analysis data demonstrates a 49% reduction in ovarian cancer risk (OR=0.51,95% CI 0.35-0.75) among women who underwent bilateral salpingectomy compared to controls in the general population 3
Opportunistic salpingectomy may prevent 42-65% of ovarian cancers in average-risk women by removing the fallopian tubes (the recognized site of origin for most high-grade serous carcinomas) while preserving ovarian function 2
This risk reduction is based on the understanding that the fimbriated portion of the fallopian tube is the site of origin for most high-grade serous ovarian cancers, both in hereditary and sporadic cases 2
Critical Distinction: High-Risk vs. Average-Risk Populations
For BRCA1/2 mutation carriers and other high-risk women, salpingectomy alone is explicitly NOT recommended as standard care:
Bilateral salpingo-oophorectomy (RRSO) achieves 80-90% risk reduction in ovarian cancer and reduces all-cause mortality by 77% in BRCA carriers 4, 1, 5
The NCCN Guidelines Panel states that despite evidence regarding safety and feasibility of salpingectomy, more data are needed regarding its efficacy in reducing ovarian cancer risk, and salpingectomy alone is not recommended as standard of care in BRCA1/2 carriers 4
Salpingectomy alone should only be reserved for women with a lifetime ovarian cancer risk of less than 5% 6
Clinical trials of interval salpingectomy with delayed oophorectomy are ongoing (NCT02321228, NCT01907789), but results are not yet available to support this approach outside of research settings 4, 7
Biological Rationale
The shift toward considering salpingectomy stems from molecular evidence:
Tubal intraepithelial carcinoma (TIC) was detected in 5-8% of BRCA1/2 carriers who underwent risk-reducing salpingo-oophorectomy, with the fimbriae or distal tube being the predominant site of origin 4
The fallopian tube is now well-established as the site of origin for most ovarian cancers, particularly high-grade serous carcinomas 7, 8
Complete removal of the fallopian tubes should be standard care during hysterectomy and/or oophorectomy, as the fallopian tube is increasingly recognized as the origin site for many high-grade serous ovarian cancers 1
Current Clinical Recommendations
For average-risk women:
- The American College of Obstetricians and Gynecologists and the Society of Gynecologic Oncology recommend that physicians counsel average-risk women regarding opportunistic salpingectomy when planning pelvic surgery 2
- Opportunistic salpingectomy is cost-effective for sterilization and cost-saving during hysterectomy 2
For high-risk women (BRCA carriers, Lynch syndrome):
- Bilateral salpingo-oophorectomy remains the treatment of choice for risk-reducing surgery 7
- Salpingectomy has been shown to reduce ovarian cancer risk in the general population and is an option for premenopausal patients with hereditary cancer risk who are not yet ready for oophorectomy, but only as a temporizing measure 4
Important Caveats
Residual risk remains: Even after complete bilateral salpingo-oophorectomy, a residual risk for primary peritoneal carcinoma persists (approximately 10-20% of the original risk), as RRSO reduces but does not eliminate ovarian cancer risk 1
No proven mortality benefit for salpingectomy alone: Unlike RRSO, which has demonstrated mortality reduction in high-risk populations, salpingectomy alone lacks long-term prospective data proving reduction in ovarian cancer mortality 4, 7
Loss of breast cancer risk reduction: BRCA carriers who undergo salpingectomy without oophorectomy may not receive the reduction in breast cancer risk that oophorectomy provides (45% reduction in BRCA1 carriers with premenopausal RRSO) 4