Recent scientific discoveries have led to a cancer prevention opportunity for women and people with ovaries who are also seeking permanent contraception. Each year, millions of people around the world choose some form of permanent contraception. A common way to prevent future pregnancies is through tubal ligation, also known as tying your tubes. This routine procedure can be scheduled as an outpatient visit, after a c-section, or one to two days after a vaginal delivery. During the procedure, the fallopian tubes are tied or cut to prevent fertilization of the egg, preventing pregnancies.
Over the last twenty years, scientists have discovered that the most common form of ovarian cancer often starts in the fallopian tubes rather than the ovaries. Thus, healthcare providers now recommend that people who are at low risk for ovarian cancer who may also desire permanent contraception can have their fallopian tubes removed while keeping the ovaries in place through a procedure called opportunistic salpingectomy. It is called “opportunistic” because the procedure is mainly offered when a person is undergoing another surgery, such as a hysterectomy (the removal of the uterus) or instead of tubal ligation.
How common and safe is opportunistic salpingectomy?
Studies have shown that the rate of opportunistic salpingectomies are significantly increasing each year and is not associated with increased risks of complications after the surgery. In a recent Canadian study, researchers show that the rate of hysterectomies that included opportunistic salpingectomy increased from approximately 15% in 2011 to 36% by 2016. The rate of tubal sterilizations that included opportunistic salpingectomy increased from approximately 7% in 2011 to 22% in 2016 across Canada1.
A review of multiple studies recently showed that salpingectomy is as safe and effective as tubal ligation for permanent contraception2. However, the review is limited by the small number of studies that were included. Although there are few studies, these studies do show that opportunistic salpingectomies are generally, very safe. These studies compared patients who underwent opportunistic salpingectomies at time of c-section or after vaginal birth to patients who underwent tubal ligations also at time of c-section or after vaginal birth. They showed that there were no differences in the amount of blood that was lost during surgery or any minor complications. There were also no significant differences in surgical time between those who underwent a salpingectomy compared to those who had a tubal ligation at the time of a c-section3, 4, 5, 6. Overall, safety evidence is reassuring.
Who should undergo these procedures?
Any individual who wishes to prevent future pregnancies are eligible. They must be aware that this procedure is irreversible, although in vitro fertilization may still be possible. Before scheduling a procedure, it is important that patients discuss with their doctor all of their options in terms of alternative contraception methods, the type of surgical technique, efficacy, safety, and any potential risks.
Ovarian cancer prevention strategy
Ovarian cancers are relatively rare but are highly deadly, with the 5-year survival rates at less than 50%. This is largely due to it being diagnosed at late stages of the disease because there is no effective screening method. It is difficult to diagnose ovarian cancers at an early stage as symptoms tend to be vague. Therefore, it is essential that prevention strategies such as opportunistic salpingectomy be used in the general population to help prevent this disease. While tubal ligations have a protective effect, studies have shown that patients who choose to have their fallopian tubes completely removed rather than tying or cutting them could have additional protection against ovarian cancer. These studies show their ovarian cancer risk can potentially be reduced by up to 64%7. It is important for people to understand the added benefit of reduced ovarian cancer risk when considering their family planning options.
References
1. Hanley GE, Niu J, Han J, et al. Opportunistic salpingectomy between 2011 and 2016: a descriptive analysis. Can Med Assoc Open Access J. 2022;10(2):E466-E475. doi:10.9778/cmajo.20210219
2. Mills K, Marchand G, Sainz K, et al. Salpingectomy vs tubal ligation for sterilization: a systematic review and meta-analysis. Am J Obstet Gynecol. 2021;224(3):258-265.e4. doi:10.1016/j.ajog.2020.09.011
3. Ganer Herman H, Gluck O, Keidar R, et al. Ovarian reserve following cesarean section with salpingectomy vs tubal ligation: a randomized trial. Am J Obstet Gynecol. 2017;217(4):472.e1-472.e6. doi:10.1016/j.ajog.2017.04.028
4. Garcia C, Moskowitz OM, Chisholm CA, et al. Salpingectomy Compared With Tubal Ligation at Cesarean Delivery: A Randomized Controlled Trial. Obstet Gynecol. 2018;132(1):29-34. doi:10.1097/AOG.0000000000002674
5. Powell CB, Alabaster A, Simmons S, et al. Salpingectomy for Sterilization: Change in Practice in a Large Integrated Health Care System, 2011-2016. Obstet Gynecol. 2017;130(5):961-967. doi:10.1097/AOG.0000000000002312
6. Subramaniam A, Blanchard CT, Erickson BK, et al. Feasibility of Complete Salpingectomy Compared With Standard Postpartum Tubal Ligation at Cesarean Delivery: A Randomized Controlled Trial. Obstet Gynecol. 2018;132(1):20-27. doi:10.1097/AOG.0000000000002646
7. Anggraeni TD, Al Fattah AN, Surya R. Prophylactic salpingectomy and ovarian cancer: An evidence-based analysis. South Asian J Cancer. 2018;7(1):42-45. doi:10.4103/sajc.sajc_187_17