Việc cắt bỏ ống dẫn trứng có thực sự làm giảm nguy cơ mắc bệnh ung thư buồng trứng không?

Ovarian cancer has a particularly poor survival rate. Only one in two women will live five years beyond their diagnosis.

There is no effective screening test, and symptoms can be hard to spot. This means ovarian cancer is often diagnosed when it is already well advanced.

But could having your fallopian tubes removed (known as a salpingectomy) work as a preventative measure?

There’s been growing interest in this online. But who is the procedure for, and how does it work? Let’s take a look at the evidence.

Who is most at risk of ovarian cancer?

Ovarian cancer is the ninth most common cancer in women in Australia. Across the general population, women have a 1% risk of developing it.

But women with certain genes have a far higher risk of developing breast and ovarian cancer. Someone who carries the BRCA1 gene has a 44% chance of developing ovarian cancer during her lifetime, and a woman with BRCA2 has a 17% chance.

Less than 1% of women carry these high–risk genes. But those who know they do – often through testing after a family member is diagnosed with breast or ovarian cancer – face a difficult decision.

Having their ovaries and fallopian tubes surgically removed reduces the risk women with these genes will develop ovarian cancer.

But this combined procedure (known as a salpingo-oophorectomy) can trigger early menopause, causing oestrogen and progesterone levels to suddenly drop, and leading to severe symptoms such as hot flushes, poor sexual function, difficulty sleeping and mood disorders.

This surgery also prevents the possibility of getting pregnant.

So the general advice is for women carrying high–risk genes to consider surgery after the age of 35 (depending on their specific genetic risk) and after they have completed their family.

But the ovaries might not be the problem

In 1999, Jurgen Piek, a Dutch PhD student, was examining a small number of surgical specimens from women with the BRCA1 gene who had had their ovaries and fallopian tubes removed.

Piek expected to find early evidence of cancer in the ovarian specimens. Surprisingly, most ovaries showed no evidence of cancer. Instead, he found evidence of early “ovarian” cancer in the fallopian tubes.

The fallopian tubes extend from the ovaries, which produce eggs, to the uterus. Around the middle of each menstrual cycle – at ovulation – the fallopian tubes sweep the egg to the uterus. If it joins with a sperm cell, conception begins. If it doesn’t, the cycle starts again.

So is ‘ovarian’ cancer the wrong name?

Piek’s findings – that most cases of ovarian cancer originate in the fallopian tubes – have now been confirmed in studies of women with both BRCA1 and BRCA2 genes as well as those with no known genetic risk.

Worldwide, this has led to a major shift in how ovarian cancer is diagnosed and reported.

Many cancers that would have once been reported as ovarian cancers are now reported as fallopian tube cancers.

It’s also led researchers to explore whether removing just the fallopian tubes (and leaving the ovaries) could prevent ovarian cancer, without the side effects.

What the evidence says

Most available studies are not randomised trials. This means they can lead to biased or misleading estimates. But the results of the studies to date do look promising.

One 2015 study looked at more than 5 million Swedish women who’d had various kinds of gynaecological surgery between 1973 and 1996 for benign indications (meaning they had no sign of cancer at the time of the surgery) and followed them until 2009. Women who’d had both fallopian tubes removed had a roughly 60% lower risk of developing ovarian cancer, compared to those who didn’t.

In 2023, a review of the international evidence reported that removing only the fallopian tubes could reduce the risk by 80%, without causing early menopause or severe menopause symptoms.

While this figure has been widely reported, 80% is based on modelling rather clinical studies. When we look at the available evidence of only clinical studies, the more accurate estimate seems to be around 50% reduced risk. But we just don’t have enough data yet to know the exact figure.

Some small trials have looked at the effects of removing the fallopian tubes “opportunistically”. This means while having another surgery, such as a hysterectomy (removing the uterus) , bariatric surgery or a gallbladder removal.

This emerging evidence is reassuring. Removing the fallopian tubes does not appear to increase the risk of complications during other types of surgery. In most cases it adds 5–15 minutes to the operating time.

Having the fallopian tubes removed can also be a safe and effective form of permanent contraception, in place of a tubal ligation (cutting or sealing the tubes) .

So is it recommended?

Internationally, many organisations representing gynaecological and cancer experts – including in the United States, Canada and Europe, as well as the International Federation of Gynecology and Obstetrics – now endorse opportunistic salpingectomy.

This means recommending that when a woman is scheduled for another abdominal or pelvic surgery, she should be offered the option of having her fallopian tubes removed too.

In 2023, the Royal Australian and New Zealand College of Obstetrics and Gynaecology guidelines recommended women be given the option of having a salpingectomy if they are having a hysterectomy, or instead of a tubal ligation.

However, the college has cautioned that more long–term studies are needed.

What this means for you

It is not currently routine in Australia to remove the fallopian tubes when a woman is having surgery for other reasons. For this to become widespread, surgeons who are not gynaecologists would likely need specific training and education. The procedure is not currently covered by Medicare.

If you have a strong family history of breast and/or ovarian cancer, you may be eligible to be tested for genes such as BRCA1 and BRCA2. If you’re concerned, you should discuss this with your GP.

For women with a high genetic risk, the recommendation remains that you have both the fallopian tubes and the ovaries removed. We don’t yet know if removing the fallopian tubes earlier – before menopause – and having the ovaries removed later would reduce ovarian cancer risk for this group.

If you’re not high–risk, but you’re having a hysterectomy, or looking for permanent contraception, you should discuss with your gynaecologist whether fallopian tube removal is an appropriate option for you.

The bottom line

These advances are a promising step towards preventing this lethal disease. But we still need more high–quality evidence to really establish how much fallopian tube removal can reduce someone’s risk of ovarian cancer.

Jenny Doust does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.