A prevention strategy pioneered in British Columbia shows that removing the fallopian tubes during routine gynecologic surgery can dramatically reduce the risk of the most lethal form of ovarian cancer. Researchers say the simple add-on could prevent thousands of cases worldwide.
A simple change in how common gynecologic surgeries are done could dramatically cut the risk of the deadliest form of ovarian cancer, according to new research led by scientists at the University of British Columbia.
The strategy, called opportunistic salpingectomy, involves removing a patient’s fallopian tubes during another routine gynecologic procedure, such as a hysterectomy or tubal ligation, often referrd to as having one’s tubes tied. The ovaries are left in place, so hormone production continues and side effects are minimal.
In a large population-based study published in JAMA Network Open, the researchers found that this approach reduced the risk of serous ovarian cancer — the most common and lethal subtype — by 78%.
The findings provide the strongest evidence yet that this surgical tweak can save lives, according to co-senior author Gillian Hanley, an associate professor of obstetrics and gynecology at UBC.
“This study clearly demonstrates that removing the fallopian tubes as an add-on during routine surgery can help prevent the most lethal type of ovarian cancer,” Hanley said in a news release. “It shows how this relatively simple change in surgical practice can have a profound and life-saving impact.”
A deadly cancer with few early warning signs
Ovarian cancer is the most lethal gynecologic cancer. In Canada alone, about 3,100 people are diagnosed each year and roughly 2,000 die from the disease.
Unlike breast or cervical cancer, there is no reliable screening test for ovarian cancer. Symptoms — such as bloating, abdominal pain or changes in appetite — are often vague and easy to overlook. As a result, many cases are not detected until the cancer has spread, when treatment is more difficult and survival rates are low.
For years, scientists believed most ovarian cancers began in the ovaries themselves. Research from British Columbia and elsewhere overturned that assumption, showing that many high-grade serous cancers actually start in the fallopian tubes, the narrow structures that connect the ovaries to the uterus.
That insight opened the door to a new kind of prevention: remove the tubes when a patient is already in the operating room for another reason, while leaving the ovaries intact.
A made-in-British-Columbia innovation
Opportunistic salpingectomy was first developed and named by Dianne Miller, an associate professor emerita at UBC and a gynecologic oncologist with Vancouver Coastal Health and BC Cancer. She co-founded OVCARE, the province’s multidisciplinary ovarian cancer research team.
Miller’s idea was straightforward: if many lethal ovarian cancers begin in the fallopian tubes, then removing those tubes during surgeries that patients are already having could prevent cancer from ever starting.
“If there is one thing better than curing cancer it’s never getting the cancer in the first place,” Miller said in the news release.
In 2010, British Columbia became the first jurisdiction in the world to offer opportunistic salpingectomy as part of routine gynecologic care. Since then, about 80% of hysterectomies and tubal ligation procedures in the province have included fallopian tube removal.
Earlier research showed that the procedure is safe, does not cause menopause to start earlier and is cost-effective for health systems. But until now, no study had clearly quantified how much it reduces the risk of serous ovarian cancer.
What the new study found
The new analysis was led by the Ovarian Cancer Observatory, a British Columbia-based international collaboration. The researchers examined health data from more than 85,000 people in British Columbia who had gynecologic surgery between 2008 and 2020.
They compared those who had their fallopian tubes removed during surgery with those who had similar operations without the added procedure. The team then tracked how many people in each group went on to develop serous ovarian cancer.
Overall, those who had opportunistic salpingectomy were 78% less likely to develop this aggressive cancer. In the small number of cases where ovarian cancer did occur after the tubes were removed, the cancers were less biologically aggressive.
To check whether their findings held up beyond British Columbia, the researchers also drew on data from pathology laboratories around the world. Those international data suggested a similar protective effect.
From local idea to global practice
What began as a provincial experiment has now spread far beyond British Columbia. Medical organizations in 24 countries recommend opportunistic salpingectomy as an ovarian cancer prevention strategy, including the Society of Obstetrics and Gynaecology of Canada, which issued guidance in 2015.
“This is the culmination of more than a decade of work that started here in B.C.,” added co-senior author David Huntsman, a professor of pathology and laboratory medicine and obstetrics and gynecology at UBC and a distinguished scientist at BC Cancer. “The impact of OS that we report is even greater than we expected.”
The researchers estimate that broader global adoption of the approach could prevent thousands of ovarian cancer cases each year.
British Columbia has already moved to expand the strategy beyond gynecologic operating rooms. The province recently became the first to extend opportunistic salpingectomy to appropriate abdominal and pelvic surgeries performed by general and urologic surgeons, through a project supported by the Government of British Columbia and Doctors of BC.
Looking ahead: making prevention routine
The new findings are likely to fuel discussions among surgeons, health systems and patients about when and how to offer fallopian tube removal as part of standard care.
Because the procedure is done during surgeries a patient is already having, it does not require a separate hospital stay or recovery period. For many, it may be an option to consider when planning a hysterectomy, tubal ligation or other qualifying abdominal or pelvic operation.
The researchers emphasize that the decision should always involve informed discussion between patients and their care teams, weighing the benefits and any potential risks in the context of each person’s health and reproductive plans.
Still, they argue that the evidence now strongly supports making opportunistic salpingectomy widely available.
“Our hope is that more clinicians will adopt this proven approach, which has the potential to save countless lives,” Huntsman added. “Not offering this surgical add-on may leave patients unnecessarily vulnerable to this cancer.”
As scientists continue to search for better treatments and, eventually, effective screening tests for ovarian cancer, this prevention strategy offers something rare in cancer care: a relatively simple, low-cost step that can stop many cases before they start.
Source: University of British Columbia