MELBOURNE – Surgical removal of the fallopian tubes could be a viable option for reducing the risk of ovarian cancer in high-risk women, a speaker said at the biennial meeting of the International Gynecologic Cancer Society.
Dr. Henrik Falconer, head of gynecologic oncology at the Karolinska Institute, Stockholm, said there is an emerging hypothesis that ovarian cancer arises primarily in the fallopian tubes, not in the ovaries, although this is difficult to prove.
Researchers therefore conducted a retrospective, population-based cohort study of women who had previously undergone sterilization; salpingectomy; hysterectomy and bilateral salpingo-oophorectomy; or hysterectomy for a benign indication between 1972 and 2010 in Sweden.
They found that women who had undergone unilateral salpingectomy had a 28% lower risk of ovarian cancer, while those who had undergone bilateral salpingectomy had a 65% lower risk, compared with the general population.
Women who underwent hysterectomy with removal of fallopian tubes and ovaries had the lowest overall risk of ovarian cancer (hazard ratio, 0.06; 95% confidence interval, 0.03-0.12), while those who had hysterectomy alone had a 22% reduction in risk.
Dr. Falconer said a case could be made for proactive removal of the fallopian tubes in women carrying the BRCA mutation, which might then enable a delay in removal of their ovaries.
“Today, we counsel the patients and advise them to take away the tubes and the ovaries, sometimes at 40-45, after they have completed their family planning,” Dr. Falconer said in an interview.
“I think now we could take away the tubes instead earlier, to have risk reduction while they wait to have their ovaries removed, perhaps in their 50s or 60s then, or maybe never.”
This would avoid the morbidity associated with oophorectomy, such as cardiovascular disease and Alzheimer’s disease, Dr. Falconer said, and could not only reduce the risk of cancer but also improve the quality of life in this population of relatively young women.
He also suggested that prophylactic salpingectomy might even be considered in women undergoing sterilization, even if they weren’t necessarily at high risk of ovarian cancer.
The study included data from more than 5 million women, with over 250,000 women exposed to some form of surgery and more than 30,000 cases of ovarian cancer.
One audience member raised concerns about the use of prophylactic salpingectomy in an otherwise healthy population, suggesting that the procedure was not without its risks and could have unintended consequences because of the loss of blood supply to the ovaries.
The study did not control for oral contraceptive use or histological subtypes.
Dr. Falconer declared support from Intuitive Surgical. There were no other conflicts of interest declared.