Can Removing Just the Fallopian Tubes Really Cut Ovarian Cancer Risk?

Ovarian cancer has a poor survival rate: only one in two women live five years beyond diagnosis, as there is no effective screening test and symptoms are easy to miss, so it is often found late. This has fuelled interest in whether removing the fallopian tubes alone, called a salpingectomy, could prevent it. The general population's lifetime risk is 1%, but women with the BRCA1 gene face a 44% risk and those with BRCA2 face 17%, though fewer than 1% of women carry these genes. Removing both ovaries and tubes (a salpingo-oophorectomy) lowers that risk but causes early menopause and ends fertility, so guidelines advise high-risk women to have it after age 35, once childbearing is complete.

The case dates to 1999, when Dutch PhD student Jurgen Piek examined ovary and tube specimens from BRCA1 carriers and found early "ovarian" cancer not in the ovaries but in the fallopian tubes, which carry eggs to the uterus. This has since been confirmed in women with BRCA1, BRCA2 and no known genetic risk, so many cancers once recorded as ovarian are now classified as fallopian tube cancers — raising the question of whether removing just the tubes could prevent cancer without the menopause side effects.

Most available studies are not randomized trials — trials that randomly assign participants to compare outcomes — so estimates could be biased, but results look promising. A 2015 study of more than 5 million Swedish women who had gynecological surgery between 1973 and 1996 for non-cancerous reasons, tracked until 2009, found those who'd had both tubes removed had a roughly 60% lower ovarian cancer risk. A 2023 review of international evidence put the reduction at 80%, though that figure comes from modeling, not clinical studies; clinical-study evidence alone suggests a more accurate estimate of around 50%, with data still limited.

Small studies of removing tubes "opportunistically," during another surgery such as a hysterectomy or gallbladder removal, found no rise in complications, typically adding just 5–15 minutes to the operation; it can also serve as permanent contraception instead of tubal ligation. Gynecological and cancer organizations in the US, Canada and Europe, and the International Federation of Gynecology and Obstetrics, now endorse this approach, and in 2023 the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended offering it during a hysterectomy or instead of tubal ligation. It is not yet routine in Australia, and is not currently covered by Medicare.