Fallopian Tube Removal Not Associated With Ovarian Cancer Risk

Women who undergo a unilateral or bilateral salpingectomy—the removal of one or both fallopian tubes—are no more or less at risk of ovarian cancer, according to new research published today in JAMA Network Open.¹

A substantial collection evidence indicates that the fallopian tube serves as the primary site of origin for a large portion of high-grade serous ovarian cancers. As a result, clinical practice guidelines recommend salpingectomy for permanent contraception when necessary rather than tubal ligation—where fallopian tubes are cut, tied, or blocked instead of removed—based on the clinical safety of salpingectomy and its potential to prevent ovarian cancer.

However, the current study found that the level of cancer risk reduction following salpingectomy was similar to that observed after tubal ligation.

“This finding suggests that if removal of healthy fallopian tubes truly reduces the risk of ovarian cancer, future studies (with additional years of follow-up) should reveal a significant and clinically meaningful decrease in cases,” the authors said. “However, the current study found no significant decrease in ovarian cancer rates in Ontario despite the increase in salpingectomy between 2003 and 2021.”

The study included 131,516 women from Ontario, Canada with a mean (SD) age of 42.2 (7.6) years, including 32,879 women who underwent a unilateral or bilateral salpingectomy and 98,637 who did not undergo any pelvic procedure. All procedures were performed between April 1992 and December 2019.

After a mean follow-up of 7.4 years in the salpingectomy group and 7.5 years in the nonsurgical control group, there were 31 cases of incident cancer (0.09%) among the salpingectomy group and 117 cases of incident cancer (0.12%) among the nonsurgical group (HR, 0.82; 95% CI, 0.55-1.21). The authors deemed the 18% reduction in risk as nonsignificant.

When comparing women who underwent salpingectomy with women who underwent hysterectomy—the removal of all or part of the uterus—the authors found a similar HR for cancer incidence of 0.87 (95% CI, 0.53-1.44), reflecting another nonsignificant risk reduction of 13%.

The study did lead to one significant finding, though. After comparing 141,698 women who underwent tubal litigation with 425,094 who did not undergo any pelvic procedure, the authors measured a significant 23% decreased risk of ovarian cancer after tubal litigation (HR, 0.77; 95% CI, 0.64-0.93; P = .006).

The authors also conducted a post hoc analysis excluding matched pairs with a unilateral salpingectomy or unknown laterality, with a mean follow-up of 5.2 years. Among 25,409 women with a bilateral salpingectomy, there were 11 cases (0.04%) of cancer diagnosed. Meanwhile, among 76,227 women who did not undergo pelvic surgery, there were 60 cases (0.08%) of cancer diagnosed. Despite a 45% decreased risk of ovarian cancer for bilateral salpingectomy compared with no surgery (HR, 0.55; 95% CI, 0.29-1.05; P = .07), this reduction was not deemed statistically significant.

According to the authors, only 4 other studies have assessed whether there is a link between salpingectomy with ovarian cancer risk, with results varying between studies and notable limitations for each. One study saw a nonsignificant 64% decrease in ovarian cancer risk among women who underwent excisional tubal sterilization compared with nonexcisional and no sterilization, and no association between tubal sterilization and risk of cancer. Meanwhile, another smaller study found a significant 42% decrease in risk after bilateral salpingectomy, but no association with unilateral salpingectomy. Another study identified a significant 65% decrease in the risk of ovarian or fallopian tube cancer with bilateral salpingectomy for benign conditions, and a significant but less substantial association between unilateral salpingectomy and reduced cancer risk. Finally, the fourth study found a substantially lower number of ovarian cancer cases among women who underwent opportunistic salpingectomy than they expected.

“Given the rarity of this disease, additional follow-up is needed to reevaluate the potential association in an aging cohort,” the authors concluded. “The increasing uptake of salpingectomy may offer an opportunity to prevent a proportion of cancers putatively arising from the fallopian tube and impact the mortality rates associated with a disease with a poor outcome.”

This article originally appeared on AJMC.

Reference

1. Giannakeas V, Murji A, Lipscombe LL, Narod SA, Kotsopoulos J. Salpingectomy and the risk of ovarian cancer in Ontario. JAMA Netw Open. 2023;6(8):e2327198. doi:10.1001/jamanetworkopen.2023.27198