Ovarian cancer risk reduction through opportunistic salpingectomy

has been increasing evidence over the past decade that the majority of ovarian cancers arise in the fallopian tube and not primarily in the ovary [1-3]. In 2010 the British Columbia Ovarian Cancer Research Group (OVCARE) launched an educational campaign about the potential benefit of " opportunistic salpingectomy " done concurrently with hysterectomy for benign gynecologic conditions, or instead of tubal ligation as surgical sterilization. It was estimated that this practice could reduce ovarian cancer risk by 20% to 40% over the next 20 years [4]. Salpingectomy is favorable to salpingo-oophorectomy because it avoids health risks associated with premature menopause after oophorectomy, including osteoporosis and coronary heart disease [5]. However, there has been skepticism about the safety and absolute benefit of this practice [6,7]. There are no long-term studies confirming that salpingectomy does not compromise ovarian function. Similarly, there are no long-term clinical studies confirming that the fallopian tube is the site of origin of most ovarian cancers. However, the available evidence so far suggests that opportunistic salpingectomy is safe, and likely to be effective and cost-effective as an ovarian cancer prevention strategy. Based on the British Columbia experience over a 4-year period from 2008 to 2011, opportunistic salpingectomy does not appear to be associated with significant perioperative risks [8]. The average additional operating room time required for salpingectomy was 16 minutes when added to hysterectomy , and 10 minutes when done instead of tubal ligation. While these differences are statistically significant, they are arguably not clinically significant. There was no increased risk of blood transfusion, prolonged hospitalization, or rate of hospital read mission associated with salpingectomy. Minig et al. [9] and Morelli et al. [10] also demonstrated that when salpingectomy was added to laparoscopic hysterectomy, there was no difference in operative time, postoperative hemoglobin, hospital stay, or complication rate. To put perioperative risks into perspective, salpingectomy as an isolated procedure for ectopic pregnancies or in vitro fertilization (IVF) has a 1.5% to 1.8% risk [11,12] compared to hysterectomy, which has a 14% to 16% risk based on systematic review [13]. When women are being counseled about salpingectomy as an additional procedure with hysterectomy, they are more likely to experience morbidity as a result of the hysterectomy, not from the salpingectomy. If they undergo tubal ligation, they have a 1.7% perioperative complication rate, which is comparable to salpingectomy [14]. However, the subsequent pregnancy rate is 0.8% after tubal ligation, and …