Risk-reducing salpingectomy: Let us be opportunistic

Because there is no screening test for ovarian cancer, effective prevention strategies may be the best way to reduce the mortality of this most lethal gynecologic malignancy. Increasing evidence supports the hypothesis that the fallopian tube is the site of origin for the vast majority of high-grade serous carcinomas. Our growing understanding of the pathogenesis of this disease offers a rare opportunity to explore new preventive measures, such as bilateral salpingectomy, which may provide great benefit without compromising ovarian function. If the tubal paradigm is accurate, then the impact of bilateral salpingectomy could extend to BRCA1 and BRCA2 mutation carriers, high-risk noncarriers, and average-risk women. The authors present a review of the literature on the role of risk-reducing salpingectomy in all women and in high-risk groups, with a focus on morbidity, ovarian function, potential clinical applicability, and epidemiological considerations. Cancer 2017;123:1714-1720. (c) 2017 American Cancer Society. Evidence points increasingly to the fallopian tube as the site of origin for a significant majority of high-grade serous carcinomas. The current findings are reviewed with respect to bilateral salpingectomy, in both high-risk and average-risk populations, as a preventive measure that may reduce mortality while preserving ovarian function. See also pages 1699-702.