Can Removing Your Fallopian Tubes Prevent Ovarian Cancer?

For decades, women with inherited genetic mutations that dramatically increase their risk of ovarian cancer have faced a difficult decision. 

The standard recommendation has been to remove both the ovaries and fallopian tubes years before natural menopause, a surgery that significantly lowers ovarian cancer risk but also triggers immediate menopause and can permanently affect quality of life. 

Now, a national study led by Karen Lu, MD, physician in chief at Moffitt Cancer Center, suggests there may be another option for some women. 

Published in JAMA Network Open, the multicenter study found that women who first removed only their fallopian tubes and delayed removal of their ovaries reported better sexual function and fewer menopausal symptoms during the first year after surgery than women who underwent the standard procedure. Researchers emphasize that larger studies are still underway to determine whether the newer approach provides the same level of long-term cancer prevention. 

A Changing Understanding of Ovarian Cancer 

Advances in genetic testing have made it easier to identify women with inherited mutations, such as BRCA1 and BRCA2, that place them at much higher risk for ovarian cancer. For these women, preventive surgery remains the most effective way to reduce that risk. 

But over the past two decades, scientists have made another important discovery: many ovarian cancers actually begin in the fallopian tubes. 

That finding prompted researchers to ask whether removing the fallopian tubes first while delaying ovary removal until later could help preserve quality of life without compromising cancer prevention. 

"We are evolving to a more nuanced prevention strategy," Lu said. "As we've understood more about the biology of ovarian cancer and we've taken care of more individuals who are otherwise healthy, we are developing more patient-centered options for prevention." 

As we've understood more about the biology of ovarian cancer and we've taken care of more individuals who are otherwise healthy, we are developing more patient-centered options for prevention.

Karen Lu, MD

Improving Quality of Life 

The trial enrolled more than 400 women at high genetic risk for ovarian cancer across nine U.S. cancer centers. Participants chose either the standard surgery that removes one or both ovaries and fallopian tubes, known as risk-reducing salpingo-oophorectomy, or interval salpingectomy with delayed oophorectomy, in which only the fallopian tubes are removed initially and the ovaries are removed later, typically at the guideline-recommended age based on a woman's inherited genetic mutation. 

Women who selected the staged approach were about half as likely to experience clinically meaningful declines in sexual function during the first year after surgery compared with women who underwent immediate ovary removal. Researchers also found fewer menopausal symptoms among women choosing the staged procedure. 

For Lu, the findings confirmed what patients had been telling physicians for years. 

"Women who just had their fallopian tubes removed did not see as dramatic a decrease in sexual function as women who were undergoing removal of their ovaries and fallopian tubes," she said. 

The study also highlighted another important finding. Women who underwent the standard surgery but received hormone replacement therapy experienced fewer menopausal symptoms and maintained sexual function better than women who did not receive hormone therapy. 

"I think the second thing that is important is that hormone replacement therapy can mitigate both menopausal symptoms and, to some extent, sexual function," Lu said. "It's really encouraging not just patients, but also clinicians to talk to patients about the importance of hormone replacement therapy in these women undergoing surgery." 

Putting Patients First 

The idea for the study did not come solely from scientists. It came from patients themselves. 

After researchers discovered that many ovarian cancers begin in the fallopian tubes, women at high genetic risk began asking whether they could remove the tubes first and postpone ovary removal until later. 

"It was really the patients who started to say, 'Isn't there another option? Couldn't we consider removing the fallopian tubes first and delaying the removal of the ovaries?'" Lu said. "They were really pushing the scientific community and the clinicians to consider this as an option."  

Lu says prevention requires a different mindset than cancer treatment because physicians are caring for otherwise healthy people. 

"When you're taking a healthy person who has not had cancer and is talking to them about prevention, saying that we're going to take something away from you in terms of your quality of life, that's a very different scenario," she said. "The way that we approach cancer prevention strategies needs to be different than when we're talking about treatment of a cancer." 

Although no ovarian cancers developed among women who underwent the staged procedure during the study's follow-up period, researchers caution that longer-term data are still needed before the approach can be considered equivalent to today's standard of care. 

An international clinical trial enrolling more than 3,000 women is now underway to determine whether the staged approach is just as effective at preventing ovarian cancer while preserving quality of life.