A Promising Tool in the Prevention of Ovarian Cancer: The Scalpel

Laura Blinkhorn, MD
March 16, 2026

Ovarian cancer is often deadly, in large part because it is diagnosed at an advanced stage in 4 out of 5 women. Compared with other cancers, the incidence is relatively low. In the United States, a woman has a 1% lifetime chance of developing ovarian cancer vs a 13% chance of developing breast cancer. When ovarian cancer is diagnosed, however, the prognosis is much more grave, with just more than 50% of women with ovarian cancer surviving more than 5 years after diagnosis vs 92% with breast cancer. Studies to find an effective screening approach through risk-based algorithms, blood tests, and ultrasonography have been disappointing. The 2018 US Preventive Services Task Force statement recommends against screening for ovarian cancer in average-risk women. Instead, a surgical approach to ovarian cancer prevention, salpingectomy (ie, removal of the fallopian tubes) is emerging as a possible strategy to reduce death from ovarian cancer. 

Our understanding of the pathophysiology of ovarian cancer has evolved. A key insight is that what was previously called ovarian cancer should actually be called tubo-ovarian cancer because it mostly begins in the fallopian tubes rather than the ovary itself. 

A subset of approximately 25% patients with ovarian cancer that is attributed to genetic mutations, such as BRCA-1 and BRCA-2, has provided even more information. Starting in the late 1990s, a preventive strategy for these high-risk patients was a prophylactic oophorectomy-salpingectomy, which reduces ovarian cancer by 80%. These patients have a much higher lifetime risk of developing invasive ovarian cancer (15%-65%), and they often prefer an aggressive surgical approach. The surgery itself has considerable downsides, however, including loss of fertility and early menopause. 

An emerging strategy for tubo-ovarian cancer prevention in average or unknown risk women is offering what is referred to as an opportunistic salpingectomy. If a surgical procedure (eg, hysterectomy) is already planned after completion of childbearing, an opportunistic salpingectomy could be offered without exposing the patient to significant additional complications. The American College of Obstetricians and Gynecologists (ACOG) has endorsed this approach for more than a decade. Studies have shown that removing the fallopian tubes while leaving the ovaries in place reduces the risk of tubo-ovarian cancer by approximately 80% without provoking premature menopause and its associated complications (eg, bone loss, cardiovascular disease). A systematic review estimated that widespread implementation of this strategy could decrease tubo-ovarian cancer mortality in the United States by 15%. It also appears to be cost-effective and does not significantly prolong surgery time. 

A European consensus statement published in 2026 endorses counseling on opportunistic salpingectomy not only before gynecologic surgeries but also for other procedures such as cholecystectomy or colorectal surgery. This might prove to be more of a logistical burden because it would entail bringing a gynecologic team into a nongynecologic surgery or training general surgeons in salpingectomy. 

The idea of prophylactic surgery has a varied and fascinating history. Although it did not become a standard practice, prophylactic appendectomy was considered for space or polar explorers to prevent rare, but potentially disastrous, medical emergencies. Incidental appendectomy during an unrelated surgery to prevent problems in the future is similarly related. Although not routinely recommended, incidental appendectomy is still sometimes performed despite being expensive and risky. A more contemporary example of preventive surgery is contralateral prophylactic mastectomy, which is the practice of removing the second breast after diagnosis of breast cancer. Guidelines recommend this for high-risk patients, but the evidence of benefit for lower risk women is much less certain.  

If the opportunistic salpingectomy approach gains ground, in the not-so-distant future, a patient having bariatric surgery or an uncomplicated appendectomy might be offered the option of having their fallopian tubes removed as well.