The Cancer-Prevention Benefits of Opportunistic Bilateral Salpingectomies
October 1, 2025 9 minutes read
By Melinda Young
EXECUTIVE SUMMARY
Interest in permanent contraception has risen by nearly 50% among women since the U.S. Supreme Court overturned the Roe v. Wade ruling of 1973.
- Most women currently seeking permanent contraception have a bilateral salpingectomy rather than the most popular procedure of a decade ago — tubal ligation.
- Evidence shows that salpingectomy can reduce a woman’s lifetime risk for ovarian cancer.
- The American College of Obstetricians and Gynecologists (ACOG) issued a statement in 2015 that opportunistic salpingectomy is a strategy for epithelial ovarian cancer prevention.
As increasing numbers of patients seek permanent contraception in the United States, it is clinically important for OB/GYNs to talk with them about an important health benefit of bilateral salpingectomy, which is a safe procedure for both permanent contraception and to prevent ovarian cancer, research shows.1-4
“A lot more women are pursuing permanent contraception since the Dobbs decision. We thought it would be a spike and fall off, but it hasn’t,” says Rebecca L. Stone, MD, MS, an associate professor at the Johns Hopkins Medicine department of gynecology and obstetrics. Stone also is the director of The Kelly Gynecologic Oncology Service and a physician in the department of obstetrics and gynecology at Johns Hopkins School of Medicine in Baltimore, MD.
A new study finds a 49.5% increase in permanent contraception procedures among women since the Dobbs decision. Investigators looked at three pre-ruling time periods, ranging from June 24, 2019, to June 23, 2022. They compared these with a post-ruling period from June 24, 2022, to May 25, 2023.1,2 About three in four to five women who seek a tubal procedure for permanent contraception receive what is now considered to be optimal — the bilateral salpingectomy, Stone adds.4
The procedure’s growing popularity is partly because of recognition that laparoscopic salpingectomy is safe and effective for permanent contraception. Although it is more likely to be associated with peri-operative and postoperative complications than laparoscopic tubal ligation, these complications are rare in both groups. A new study found that the rate of major complications for salpingectomy was 2.1% vs. 0.7% for tubal ligation; the rates for minor complications were 2.8% for salpingectomy and 1.8% for ligation.4
Stone’s research demonstrates that increased interest in permanent contraception creates an opportunity for clinicians to share data with patients about the two procedures. They can discuss their safety, efficacy at preventing pregnancy, and how salpingectomy has the added benefit of reducing the risk of ovarian cancer.1
“The Dobbs article is so important because the single most common time a woman might consider a bilateral salpingectomy is when they are considering permanent contraception,” Stone explains. As more people seek permanent contraception, it is a good opportunity for clinicians to offer salpingectomy because that also could protect them from ovarian cancer, she adds.
“The majority of permanent contraception is the salpingectomy, but — still — one in four or five women are having a tubal ligation, and that’s a lot of people,” she says. “It eats me up because I take care of people with newly diagnosed ovarian cancer,” Stone says. “All the grief and loss and devastation of this disease and knowing that some people are going to the operating room to get a ligation — I literally can’t sleep, thinking about it.”
For decades, women who wanted to permanently prevent pregnancy had the procedure tubal ligation, popularly known as having “tubes tied.” The procedure is not designed to be reversible, although some patients and even providers thought it could be. Then, new research showed that ovarian cancer, which is the deadliest cancer of the female reproductive system according to the Centers for Disease Control and Prevention, often begins in the fallopian tubes.5
The American College of Obstetricians and Gynecologists (ACOG) issued a statement in 2015 that it was ACOG’s committee opinion that opportunistic salpingectomy is a strategy for epithelial ovarian cancer prevention.6 “By performing salpingectomy when patients undergo an operation during which the fallopian tubes could be removed in addition to the primary surgical procedure (e.g., hysterectomy), the risk of ovarian cancer is reduced,” ACOG says.6
Since then, more data have shown the benefits of removing fallopian tubes when they are no longer needed for reproductive purposes. For example, Canadian researchers published one of the first with prospective evidence, in 2022, that bilateral salpingectomy may substantially decrease the risk of high-grade serous carcinoma for women in the general population.2,3
Researchers studied a large cohort of people in British Columbia who underwent opportunistic salpingectomy, control surgery of hysterectomy alone, or tubal ligation between 2008 and 2017. Participants either had their fallopian tubes removed at the time of hysterectomy, or they had them removed instead of having tubal ligation while leaving ovaries intact. Among the 25,889 people who underwent opportunistic salpingectomy, there were no serous ovarian cancers and there were five or fewer epithelial ovarian cancers. By contrast, there were 15 serous cancers in the control group, and investigators calculated that there would be 45.1 serous ovarian cancers in that group by 2027.3
“The data is tracking to show that salpingectomy decreases risk of serous ovarian cancer by 80%, which is a really big deal,” Stone says. “We don’t have a screening test for ovarian cancer, and we can’t visualize a fallopian tube with medical imaging, so most women diagnosed are diagnosed with advanced disease.”
Removing women’s ovaries would be a more problematic procedure because the ovaries continue to make hormones after menopause, and removing them could lead to more discomfort, she notes. “But the fallopian tubes have no known function, and so their removal doesn’t affect how we feel as we get into our late 50s,” Stone explains. “It’s a reasonable strategy, and my goal in life is to get up and do the work to make sure everybody is aware of this and is able to choose it for an option.”
Stone explains that ovarian cancer surgery is very difficult and often requires her to spend 14 hours in surgery. Strategies to reduce ovarian cancer in the United States will save physicians and patients a lot of heartache. One such strategy is to convince OB/GYNs and patients to use salpingectomy instead of tubal ligation — no matter their reason for seeking a tubal procedure.
“We should end tubal ligation altogether,” she says. “My feeling is it should be a discussion between patient and provider, talking to women about the difference between ligation and salpingectomy and giving them the agency to have informed decision-making with salpingectomy.”
Policy work and research on ovarian cancer and women’s reproductive health are raising awareness of the procedure’s benefits. The benefits of salpingectomy for cancer prevention are being researched in multiple countries. In the United States, the Break Through Cancer project in Cambridge, MA, has two projects tackling ovarian cancer. One project aims to develop a national strategy for ensuring access to fallopian tube removal as a preventive procedure for women.7
The Johns Hopkins Center for Communication Programs participates in the Outsmart Ovarian Cancer project that seeks solutions to increasing knowledge about the removal of fallopian tubes as an ovarian cancer prevention method.8
Bilateral salpingectomy could be offered at the time patients schedule hysterectomy procedures, as well as used as permanent contraception for pregnant patients after they give birth. “One of the most common times women are thinking about whether they want permanent contraception or tubal ligation is at their last delivery — either a c (cesarean)-section or vaginal delivery and right after the baby is born,” Stone says.
Even pregnant women who do not ask about permanent contraception could be told about the procedure and its cancer-preventing benefits. For example, some older women who give birth after in vitro fertilization or other fertility-enhancing procedures may not want to have any more pregnancies. They may not think about asking for a salpingectomy for permanent contraception, since they do not believe that would be an issue for them. However, they might say they would like to have it done to prevent cancer.
Women with a history of ovarian cancer may plan one of the procedures. But since most women who have ovarian cancer have no known risk factors, it also is possible to make it an option for those planning non-reproductive procedures like a gall bladder procedure, Stone says.5 “A surgeon could talk to women about that,” she says.
Cost is a chief obstacle to offering the procedure to post-menopausal women, who are at risk of ovarian cancer as much as those in their reproductive years. The procedure may not be fully covered by insurers. OB/GYNs could train other physicians to do the procedure so that when they have a patient with a separate, planned procedure, salpingectomy could be added to it at a low cost to the patient, she says.
“Medicine needs an overhaul, and we need to do educational textbooks and teach patients and providers about this — not just surgeons,” Stone says. It would help if OB/GYNs spoke about the procedure in community settings and discussed it with religious leaders, to whom patients often go for advice, she adds.
Religious leaders who condemn contraception and sterilization might be receptive to a procedure for post-menopausal women when it could save their lives and could not possibly prevent future pregnancies, Stone notes. “I think there is no reason for a woman who is post-menopausal to have their tubes removed for birth control, so the reason would be for either prevention of cancer or to treat some sort of benign disease process in the fallopian tubes,” she explains.
Women of reproductive age have easier access to the procedure. “For women of reproductive age, the Affordable Care Act makes the choice of contraception a universal right that insurance is supposed to cover,” Stone explains. “But bilateral salpingectomy has not been offered as an alternative to tubal ligation.”
OB/GYNs often get around this by billing salpingectomy at the same cost as tubal ligation, even though the procedure would cost more. When this happens, they may not fully inform patients about how the tubal procedure the patient requested would be a total removal of the fallopian tubes, and some patients express surprise when they see their post-procedure chart, she notes.
A better counseling strategy would be to make certain patients understand which procedure will be done and how it will permanently prevent pregnancy with no chance of reversal, she says. “You could say, ‘Listen, it sounds like you’re interested in permanent contraception, and most people have really only understood the option of tubal ligation, which is when the fallopian tube is either blocked or interrupted so sperm can’t meet egg,’” Stone says. “’Now, we know most ovarian cancers come from the fallopian tube and not the ovary, and so you might want the tube removed, and it’s called a salpingectomy, and this is absolutely irreversible.’”
Then, physicians could explain that even though tubal ligation is potentially reversible, it should be considered nonreversible. Anyone who wants a potentially reversible method should select a different option, she adds.
Robert Hatcher, MD, consulting editor of Contraceptive Technology Update, founding author of Contraceptive Technology, and professor emeritus of gynecology and obstetrics, Emory University School of Medicine in Atlanta, has several observations about permanent contraception. First, in the United States, 23.7% of contracepting couples count on permanent contraception (18.1% use tubal surgery and 5.6% use vasectomy), he says.9 For the past 70 years, sterilization has been the most commonly used method of contraception in the United States and the world, he says.
Second, over the past 10 years, total bilateral salpingectomy has been recommended by the American College of Obstetricians and Gynecologists and is generally the approach to tubal sterilization being used. When total bilateral salpingectomy is the method used, the failure rate is 0.0%, Hatcher says.9
Third, the latest means of permanent tubal sterilization, bilateral salpingectomy, is estimated to lower a patient’s lifetime risk of ovarian cancer by 49%, and that includes serous carcinoma, the more serious form of cancer, Hatcher says.9 Occlusive techniques of tubal sterilization lower a patient’s lifetime risk of ovarian cancer by 24% to 36% (somewhat less than the reduction in ovarian cancer when bilateral salpingectomy is performed), he says.9
Fourth, as to the potential protective effect of tubal surgery against breast cancer, Hatcher notes that one prospective cohort study of 619,199 patients suggested an inverse association between tubal surgery and breast cancer mortality (RR, 0.82).9 There was a greater lowering of the risk of breast cancer mortality related to younger age at the time of surgery (RR among women before age 35 years, 0.69), Hatcher says.9
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Lulseged BA, Rockwell TL, Wang KC, et al. Female permanent contraception procedures surrounding the Dobbs v. Jackson ruling at a single institution. J Womens Health (Larchmt). 2025;34(6):810-816.
2. Kahn RM, Gordhandas S, Godwin K, et al. Salpingectomy for the primary prevention of ovarian cancer: A systematic review. JAMA Surg. 2023;158(11):1204-1211.
3. Hanley GE, Pearce CL, Talhouk A, et al. Outcomes from opportunistic salpingectomy for ovarian cancer prevention. JAMA Netw Open. 2022;5(2):e2147343.
4. Patel VJ, Patel D, Toumazos K, Son Y. Peri- and postoperative complications of laparoscopic tubal ligation versus salpingectomy for permanent contraception: An ACS-NSQIP analysis. Laparosc Endosc Robot Surg. 2025;8(2):84-89.
5. Centers for Disease Control and Prevention. Ovarian cancer statistics. June 10, 2025. https://www.cdc.gov/ovarian-cancer/statistics/index.html
6. Committee on Gynecologic Practice. Committee Opinion Number 774: Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention. American College of Obstetricians and Gynecologists. April 2019. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/04/opportunistic-salpingectomy-as-a-strategy-for-epithelial-ovarian-cancer-prevention
7. Break Through Cancer. Ovarian cancer. https://breakthroughcancer.org/projects/ovarian-cancer/
8. Desmon S. Understanding an underused surgery to reduce ovarian cancer risk. Johns Hopkins Center for Communication Programs. Dec. 16, 2024. https://ccp.jhu.edu/2024/12/16/salpingectomy-ovarian-cancer-risk-hcd-sbcc/
9. Brown JA, Hou MY. Permanent contraception. In: Cason P, Cwiak C, Edelman A, et al, eds. Contraceptive Technology, 22nd ed. 2025:223, 224, 228, 231.
As increasing numbers of patients seek permanent contraception in the United States, it is clinically important for OB/GYNs to talk with them about an important health benefit of bilateral salpingectomy, which is a safe procedure for both permanent contraception and to prevent ovarian cancer, research shows.
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