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    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.

    Illustration by Alex Baker, DNA Illustrations, Inc.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?

     

     

    Alicia Saunders, MD
    Dr Saunders is Instructor in the Department of Obstetrics and Gynecology, Mount Sinai West and Mount Sinai St. Luke’s Hospitals, Mount ...
    Lisa Anderson, MD
    Dr Anderson is Assistant Professor in the Department of Obstetrics and Gynecology, Mount Sinai West and Mount Sinai St. Luke’s ...
    Peter G. McGovern, MD
    Dr McGovern is Professor in the Department of Obstetrics and Gynecology, Mount Sinai West and Mount Sinai St. Luke’s Hospitals, Mount ...

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    • Anonymous
      Thank you for this great article, I will share it with my patients that hesitate to have this done instead of a tubal ligation. My only question would be in a younger patient eg. <28 year old who wishes to have a tubal ligation, I usually perform a falope ring to leave enough tube in case of remorse and desire to have tubal reversal years later. I know I should not think of a reversal, but sometimes these women have regret and they cannot afford IVF, but have enough money to afford a tubal reversal and get pregnant.
    • Anonymous
      Thank you for this great article, I will share it with my patients that hesitate to have this done instead of a tubal ligation. My only question would be in a younger patient eg. <28 year old who wishes to have a tubal ligation, I usually perform a falope ring to leave enough tube in case of remorse and desire to have tubal reversal years later. I know I should not think of a reversal, but sometimes these women have regret and they cannot afford IVF, but have enough money to afford a tubal reversal and get pregnant.
    • UBM User
      Distal salpingectomy has become a common procedure in my practice. I offer it and perform it during hysterectomies, and it is my only option for sterilization. ACOG should develop a CPT code specific for the latter modality as billing has required a lot of improvisation as there is no CPT code that applies to this procedure.

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