Why women should have their fallopian tubes removed after having children to protect themselves from a ‘silent killer’, a leading cancer expert reveals

As a surgeon treating patients with advanced ovarian cancer, my job has its fair share of dark moments.

This nasty disease is particularly difficult to diagnose. There is no test for it and there are often no early symptoms. By the time they do appear (such as bloating or abdominal pain), the cancer is usually already advanced.

It’s no wonder that ovarian cancer is sometimes called the “silent killer.”

When a patient is finally diagnosed (there are around 7,500 new cases of ovarian cancer in the UK each year and around 4,100 people die from ovarian cancer), surgeons like me face the harsh conditions.

Last but not least, the average survival rate after five years is less than 50 percent. That is lower than for breast or lung cancer, because the disease is often discovered too late.

Only 20 percent of ovarian cancer cases in the UK are detected early.

That is why we must look for ways to prevent the disease, rather than desperately trying to catch up once it has been diagnosed.

We need to find ways to prevent the disease rather than desperately trying to catch up once the diagnosis is confirmed, writes Professor Michael Worley

We already do this with preventive surgery (removal of risk tissue) in women with a family history of breast or ovarian cancer. This is usually done after a defective gene has been discovered that is associated with a high risk of developing these diseases.

But I firmly believe that we can also help the many thousands of others who do not have this genetic risk by performing surgery to remove the fallopian tubes in women who are already candidates for other pelvic or abdominal surgeries, including hysterectomy, removal of fibroids, caesarean section or even removal of the gallbladder.

This surgery is known as an opportunistic salpingectomy and is most often performed as a form of permanent birth control, but also to treat conditions such as ectopic pregnancy or endometriosis.

Yet few people realize that it could also protect many more women from ovarian cancer, provided they are sure they do not want any more children (the procedure leads to infertility).

In fact, research shows that removing the fallopian tubes reduces a woman’s risk of ovarian cancer over her lifetime to virtually zero.

But how does removing the fallopian tubes prevent ovarian cancer?

The term ovarian cancer is actually misleading, because the disease mainly starts in the fallopian tubes and then spreads to the ovaries.

Only a small percentage of (usually rare) forms of ovarian cancer actually arise in the ovaries.

This is important because unlike removal of the ovaries (which can lead to surgical menopause and increase the risk of cardiovascular disease and osteoporosis), removing the ovaries carries no risk. The fallopian tubes have no other function than to transport the egg.

Removing them will not cause early menopause because the ovaries (which determine menopausal status through hormone production) remain intact.

Ovulation therefore occurs normally, but the released eggs simply dissolve.

And there is no additional risk of bleeding, because the fallopian tubes are not located in an area with many blood vessels (there is a limited blood supply).

Furthermore, the procedure is quick and easy. Removing the 4-5 cm tubes takes only a few minutes.

That’s why surgery – for the right women – can be a huge game changer in our fight against ovarian cancer.

That’s why I’m part of an initiative involving five top cancer centers in the U.S., including the Dana-Farber Cancer Institute, where I work, to make more women and doctors aware of the procedure.

We want doctors in the UK and around the world to follow this example.

Some countries are already on board. Canada’s ovarian cancer risk dropped after salpingectomy was recommended for women undergoing hysterectomy in 2010.

Yet most patients worldwide – and many doctors – still have no idea that ovarian cancer starts in the fallopian tube and that opportunistic salpingectomy can significantly reduce the risk.

To continue to perform this protocol, general surgeons must be trained in the technical aspects of tubal ablation.

In an ideal world, it would be offered to all women who have pelvic or abdominal surgery and who do not want to have any more children. The average age of ovarian cancer diagnosis is 63, but we believe that fallopian tube cancer takes several years to develop – so the earlier this procedure can be done, the better.

Is it using a sledgehammer to crack a nut? Absolutely not.

We have been trying to find early diagnoses and screening methods for this disease for decades, but nothing works and no screening mechanism (imaging, blood tests, etc.) is even remotely useful.

Rather than continuing the decades-long fruitless pursuit of early detection, we propose a new strategy: prevention.

I have treated thousands of women with poor prognosis who wondered why modern medicine could not cure them.

Of patients who go into remission after extensive surgery and aggressive chemotherapy, approximately 70 to 80 percent experience a relapse.

Even after treatment, microscopic bits of cancer may remain in the blood or abdominal cavity because the original disease can spread over a large area.

And once the cancer comes back, it is almost always terminal.

Every conversation is heartbreaking. So without early symptoms of this terrible disease, this relatively simple procedure is the most powerful tool we have.

Professor Michael Worley is Director of the Division of Ovarian Cancer Surgery at Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston, USA.

As told to ANGELA EPSTEIN