Bilateral salpingectomy: An opportunity to reduce cancer risk
None of the authors has a conflict of interest to report in respect to the content of this article.
Here we outline the rationale and data supporting a policy of performing bilateral salpingectomy (BS) at the time of benign gynecologic intra-abdominal surgery in post-reproductive-age women, including a proposal to use BS to replace other methods of tubal sterilization.
In 2011, The Society of Gynecological Oncology of Canada issued a statement recommending that “physicians discuss the risks and benefits of bilateral salpingectomy with patients undergoing hysterectomy or requesting permanent, irreversible sterilization.”1 This practice statement reflects robust histological, immunohistochemical and molecular evidence that most high-grade serous epithelial ovarian cancers (HGSC) in BRCA1/2 + women—and in many women with sporadic, non-hereditary pelvic serous carcinomas—actually originate from the distal portion of the fallopian tube.
Experience with risk-reducing salpingo-oophorectomies in healthy carriers of BRCA mutations revealed that a significant percentage (5%-10%) had pre-existing distal tubal precursor or serous tubal intraepithelial carcinoma (STIC) lesions, mostly in association with p53 mutations.2 Subsequently, analysis of fallopian tube histology slides from cases of women diagnosed with sporadic, non-hereditary ovarian serous carcinoma revealed STIC lesions in up to 50% to 60% of these cases.3
This paradigm shift is provocative on several levels. It challenges existing concepts about the origin of epithelial ovarian cancer and in so doing provides novel opportunities for prevention of ovarian cancer in both high-risk women and for women in the general population.
It also raises two questions: (1) Is there any additional risk to incorporating BS into other gynecologic surgeries? and (2) what are the consequences of the remaining ovaries?