Identifying Potential Missed Opportunities to Prevent Ovarian Cancer
November 1, 2025 6 minutes read
By Melinda Young
A new study found that nearly one in four ovarian cancer patients with high-grade serous cancer (HGSC) could have been offered bilateral salpingectomy at the time of a prior abdominal surgery, potentially preventing their cancer diagnosis.1 “Unfortunately, ovarian cancer is a very aggressive disease diagnosed in the later stages, and we have yet to find a screening test to identify ovarian cancer early,” says Sara Moufarrij, MD, a gynecologic oncology fellow at Memorial Sloan Kettering Cancer Center in New York, NY.
When screening for cancer, antigen 125 and a pelvic ultrasound were used to identify ovarian cancer early, and there was no significant reduction in ovarian-related and fallopian tube-related cancer deaths, according to findings in the UK Collaborative Trial of Ovarian Cancer Screening.1 “They have been trying for years to find an appropriate screening tool, and we haven’t found one yet,” Moufarrij says.
Clinicians know how to identify people with specific mutations like BRCA1, BRCA2, and others that have much higher risk of developing ovarian cancer. But they do not know what to do about the three in four potential ovarian cancer patients who have no known risk factors, she adds. “It’s shown in international studies that opportunistic salpingectomy at time of another abdominal surgery could help those at average risk,” she explains. “This procedure is overall safe, easy, and quick, and a big study out of Canada shows it’s effective, with an 80% reduction in ovarian cancer by just removing the fallopian tubes.”1
The American College of Obstetricians and Gynecologists (ACOG) and other organizations recommend that opportunistic bilateral salpingectomy be discussed and recommended for patients who are having a hysterectomy. (See article about salpingectomy and ovarian cancer prevention in the October 2025 issue of Contraceptive Technology Update.)
“That’s now considered standard of care,” Moufarrij says. “We were thinking that maybe we could integrate the removal of fallopian tubes at the time of other surgeries,” she says. “This is an area being studied currently, and we were interested in evaluating the frequency of surgeries and what time the opportunistic salpingectomy could have been performed.”
The study’s authors defined a missed opportunity as one of two things: first, did the patient have a surgical procedure that resulted in permanent contraception, such as tubal ligation or hysterectomy without concurrent salpingectomy, or secondly, did they have another abdomino-pelvic surgery at age 45 years or older when salpingectomy could have been performed one year or more preceding the person’s diagnosis of high-grade serous cancer.1 “We took a cohort of people who had ovarian cancer to see which point they could have had opportunistic salpingectomy at the time of the other procedure,” Moufarrij explains. “We found a considerable proportion of these patients could have had it but missed the opportunity to have their tubes removed.”
Since scientific literature has increasingly shown the benefit of bilateral salpingectomy in recent years, clinical practice and standard of care also could evolve based on the latest evidence. “In the early 2000s, even 2010 and 2016, the standard of care was to not remove the whole fallopian tube, but to perform tubal ligation,” she says. “[This changed] after ACOG made recommendations in 2017 for salpingectomy to be performed rather than tubal ligations for patients who no longer wanted to maintain their fertility.”
Tubal ligations do not prevent cancer as much as a bilateral salpingectomy, Moufarrij notes. “The most common cancer subtype originates [in the fallopian tubes]. When they tie off the middle portion of the fallopian tube, it stops the egg from moving through the ovary and uterus,” she explains. “Tubal ligation is not resecting cells that can harbor cancer, but if you do a full salpingectomy, you’re removing every aspect of the fallopian tube up to the uterus.”
Researchers are studying the best preventive surgical option for people who carry the mutations that put them at greatest risk of ovarian cancer, she adds. “The WISP trial is looking at removal of fallopian tubes with delayed removal of ovaries,” Moufarrij says. “They are monitoring patients over time with ovarian resection over three years; the patients are young, and their ovaries are important for their bone health, cardiovascular health, mental health, and prevention of mood disorders.”
Researchers involved with the TUBA-WISP II trial are comparing two surgical options for the prevention of ovarian cancer. One is risk-reducing salpingectomy with delayed risk-reducing oophorectomy, meaning patients would have their fallopian tubes removed but have one or both ovaries removed at a later time. The other is risk-reducing salpingo-oophorectomy, which is when both fallopian tubes and one or both ovaries are removed at the same time. The latter is the current standard-of-care option for ovarian cancer prevention for people who carry the BRCA1 or BRCA2 mutations.2,3
There is a trend of women having children at an older age, and they may think this is the only pregnancy they will have, so clinicians could counsel those patients — as well as those with genetic risk of ovarian cancer — on the cancer-preventing benefits of an opportunistic salpingectomy, Moufarrij says. “We will talk with them separately about having salpingectomy at the time of their c-section or vaginal delivery,” she adds. “When I trained in residency in Houston, at that time, the majority of our providers were still doing tubal ligations at vaginal deliveries because the data wasn’t as strong as it is now.”
There also are some medical considerations for performing a salpingectomy at the time of childbirth, she notes. “The fallopian tubes at the time of pregnancy are large and vascular with a lot of blood vessels, so doing a full fallopian salpingectomy has more risk associated with it than tubal ligation,” Moufarrij explains. “Now that we know there is strong data showing salpingectomy can reduce risk of ovarian cancer, we’re adopting surgical methods to this.”
Another factor is that insurers have not caught up with the recommendations, and opportunistic salpingectomy is not yet a billable procedure for surgeons. They bill it under tubal ligation, she adds.
The other roadblocks are physician shortages and work overloads, leading to little time to learn new recommendations and update practices. “Physician burnout is multifactorial, including paperwork,” Moufarrij says. “At MSK, we have so much support, ancillary staff, to help us with paperwork. But a lot of hospitals are not appropriately funded to have that support, so physicians have to do everything, and it’s too much for them.”
Also, healthcare recommendations move very slowly on the road to becoming standard clinical practice in the United States, and this is especially true for recommendations pertaining to female health, she says. “I really feel strongly about this,” Moufarrij says. “We are performing these colon-rectal surgeries, and if a patient vocalizes she doesn’t want children anymore, we can do the salpingectomy, too, and we can teach general surgery colleagues to do this.”
There are many disparities in healthcare outcomes and practices in the United States, and this is one area that physician advocates have to focus on in the next few years, she says. “We have to implement nationwide policy changes,” Moufarrij says.
“In addition to lobbying the government on the federal and state levels, we have to educate nurse practitioners and surgeons and go to hospitals to talk through the data behind this and advocate for opportunistic [bilateral] salpingectomy,” she adds. “It’s such an easy procedure that has minimal risk and adds almost no surgical time; there’s minimal risk of bleeding, and it could save a woman’s life.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Moufarrij S, Hazimeh D, Rockwell T, et al. Gauging the magnitude of missed opportunity for ovarian cancer prevention. JAMA Surg. 2025;Aug 13:e242810.
2. TUBA-WISP II Trial (Ovarian Cancer) — Clinical Trial. Duke Health. https://www.dukecancerinstitute.org/clinical-trials/tuba-wisp-ii-trial-ovarian-cancer
3. Steenbeek MP, van Bommel MHD, intHout J, et al. TUBectomy with delayed oophorectomy as an alternative to risk-reducing salpingo-oophorectomy in high-risk women to assess the safety of prevention: The TUBA-WISP II study protocol. Int J Gynecol Cancer. 2023;33(6):982-987.
A new study found that nearly one in four ovarian cancer patients with high-grade serous cancer (HGSC) could have been offered bilateral salpingectomy at the time of a prior abdominal surgery, potentially preventing their cancer diagnosis.
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