Salpingectomy as a potential ovarian cancer risk-reducing procedure.

Accumulated evidence over the past 10 years has strongly indicated that the fallopian tube is the site of origin for many high-grade serous carcinomas (1), which represent 50% to 60% of all epithelial ovarian cancers. This multi-origin model of ovarian cancer development has important implications for prevention of ovarian cancer: if some or all high-grade serous tumors develop in the fallopian tube, then bilateral salpingectomy could prevent this most aggressive form of ovarian cancer. However, to date, no large-scale data regarding the impact of salpingec-tomy on ovarian cancer incidence have been available. The article by Falconer et al. (2) is the first to address this question. This study combined data from several population registries in Sweden to compare incidence of ovarian cancer in women with a previous gynecologic procedure for benign indications (salpingectomy, tubal ligation, total abdominal hysterectomy with bilateral salpingo-oophorectomy [BSO], and hysterectomy without concomitant bilateral salpingo-oophorectomy [TAH]) to women with no history of these surgeries. They reported a statistically significant 35% lower risk of ovarian cancer among women with a previous salpingectomy compared with women with no previous surgeries. Consistent with previous studies, all other gynecologic surgeries evaluated in this study were associated with lower ovarian cancer risk, ranging from a 21% lower risk associated with TAH to a 94% lower risk with BSO. It is well established that BSO almost entirely eliminates the risk of ovarian cancer; BSO is commonly used as an ovarian cancer risk-reducing measure in women with inherited BRCA mutations. However, BSO is not without side effects. First, in young women, this surgery results in early menopause, which is associated with increased risk of cardiovascular diseases, neuro-logical diseases, psychiatric diseases, osteoporosis, and overall mortality (3). Further, studies have demonstrated that post-menopausal women with BSO compared with TAH alone have increased overall mortality and increased risks of cardiovascular and neurologic diseases (4). Therefore, given the risks associated with BSO compared with the low lifetime risk of ovarian cancer in women without BRCA mutations (1 in 72), BSO is not recommended on a population level for prevention of ovarian cancer. The finding that many high-grade serous ovarian cancers arise in the fallopian tube has thus prompted the question: Could sal-pingectomy be a safer, but still effective, alternative to BSO for ovarian cancer prevention? The results provided in the Swedish study suggest that salpingectomy may reduce the risk of ovarian cancer, but to a lesser degree than …