Missed Opportunities for Salpingectomy Highlight Gaps in Ovarian Cancer Prevention

A large proportion of patients with high-grade serous cancer (HGSC) had undergone prior surgeries during which a salpingectomy could have been performed to help prevent ovarian cancer, according to a study published in JAMA Surgery.¹

The researchers highlighted opportunistic salpingectomy, the surgical removal of the fallopian tubes during another elective abdominal procedure, as an emerging intervention for ovarian cancer prevention in people with a 1% to 2% lifetime risk. This approach is supported by evidence that most ovarian cancer cases originate in the fimbriated end of the fallopian tube rather than the ovarian surface epithelium and is projected to reduce HGSC risk by nearly 80%.

Consequently, the National Comprehensive Cancer Network guidelines recommend salpingectomy as an option to reduce ovarian cancer risk among average- or uncertain-risk patients undergoing surgical sterilization.² Robust data also support opportunistic salpingectomy as the standard of care at the time of hysterectomy and as an alternative to tubal ligation.³

Still, the researchers noted that additional opportunities may exist for incorporating this preventive approach into routine surgical practice.¹ To explore this, they conducted a study to assess how often patients later diagnosed with HGSC had prior surgeries where opportunistic salpingectomy could have been performed. The researchers also examined how these missed opportunities overlapped with those for germline genetic testing and reflex risk-reducing surgery.

Many patients later diagnosed with high-grade serous cancer had prior surgical or genetic testing opportunities that could have reduced their ovarian cancer risk, underscoring the need to expand opportunistic salpingectomy and preventive strategies. | Image Credit: shidlovski - stock.adobe.com

To do so, they performed a retrospective cohort study and a cross-sectional survey of patients with HGSC from the Ovarian Cancer Research Alliance (OCRA). Missed opportunities for opportunistic salpingectomy were defined as either permanent contraception at any age or abdominopelvic surgery at age 45 or older occurring at least 1 year before HGSC diagnosis when salpingectomy could have been performed but was not. The reproductive age threshold was 45 years, as 80% of women aged 45 to 50 years report contraceptive use and nearly 90% completed childbearing by that age.

The retrospective cohort study reviewed medical records of women treated for HGSC at Johns Hopkins or Memorial Sloan Kettering Cancer Center between June 2015 and June 2021. The researchers calculated the proportion at risk for ovarian cancer with missed opportunities for genetic testing and/or risk-reducing surgery. Patients at risk included those with genetic susceptibility or a first-degree family history. They also identified the proportion of patients diagnosed with HGSC despite prior bilateral salpingectomy or bilateral salpingo-oophorectomy.

To address the limitations of the record review, cross-sectional survey data were gathered to validate findings from the retrospective study. The survey, developed in collaboration with physicians, patients, and patient advocates, collected surgical and demographic data. OCRA distributed the survey to its nationally representative network from February 15 to April 19, 2023.

The retrospective cohort included 1877 patients with HGSC, 445 of whom had tubal ligations, hysterectomies, or abdominopelvic surgeries at age 45 or older, representing missed opportunities for opportunistic salpingectomy. Specifically, 241 were sterilization procedures, and 242 were abdominopelvic surgeries at 45 years or older.

The sterilization procedures comprised 131 hysterectomies without concurrent salpingectomy and 110 bilateral tubal ligation/occlusion procedures. Among abdominopelvic surgeries, they included 72 cholecystectomies (29.8%), 61 gynecologic procedures (25.2%), 39 appendectomies (16%), 34 hernia repairs (14%), and 20 bowel surgeries (8.3%). Overall, 37% of missed opportunities were attributable to nongynecologic intra-abdominal procedures performed in patients aged 45 or older.

Additionally, 111 patients (6%) had a first-degree family history of ovarian cancer. Of this subgroup, 43.2% were found to have genetic susceptibility on germline genetic testing only after their HGSC diagnosis, representing another missed opportunity for testing that could have prompted risk-reducing surgery.

In the cross-sectional survey study, 348 of the 917 respondents reported an HGSC diagnosis and were eligible for analysis. Of this population, 40 reported a history of bilateral tubal ligation or hysterectomy without concurrent salpingectomy (11.5%), and 14 reported a history of abdominal surgery at age 45 or older (4%), meaning 15.5% had a missed opportunity for opportunistic salpingectomy.

The researchers acknowledged several limitations, including the use of a 45-year age cutoff and the lack of information on surgical urgency or indication. These factors may have contributed to both under- and overestimation of missed opportunities. Still, given the current lack of screening and treatment options, they emphasized the importance of recognizing the full spectrum of HGSC prevention opportunities.

“…the future of ovarian cancer prevention is poised to evolve toward targeted salpingectomy based on polygenic risk modeling and individualized risk stratification,” the authors concluded. “Until then, ovarian cancer prevention may indeed offer a proverbial pound of prevention, far preferable to the tons we currently spend battling a cancer for which only ounces’ worth of curative treatment options exist."

References

1. Moufarrij S, Hazimeh D, Rockwell T, et al. Gauging the magnitude of missed opportunity for ovarian cancer prevention. JAMA Surg. Published online August 13, 2025. doi:10.1001/jamasurg.2025.2810
2. National Comprehensive Cancer Network. NCCN BRCA guidelines (version 2.2025). Accessed August 27, 2025. https://www.nccn.org/professionals/physician_gls/pdf/genetics_bopp.pdf
3. Kahn RM, Gordhandas S, Godwin K, et al. Salpingectomy for the primary prevention of ovarian cancer: a systematic review. JAMA Surg. 2023;158(11):1204-1211. doi:10.1001/jamasurg.2023.4164