Fallopian tube removal cuts ovarian cancer risk by 80%

Doctors and UK health bodies are urging surgeons to offer fallopian tube removal to women over 45 undergoing abdominal surgery to cut ovarian cancer risk.

The preventative procedure, known as an opportunistic salpingectomy, adds just five minutes to an existing operation such as a gallbladder removal, hernia repair, or caesarean section. Medical experts say removing the tubes can slash a woman's risk of developing deadly ovarian cancer by up to 80 per cent while introducing minimal additional surgical risk.

Ovarian cancer strikes more than 7,000 British women each year, with one in 50 women developing the disease during their lifetimes. Around 4,000 women in the UK die from the condition annually. Dubbed a silent killer because it produces few symptoms until it spreads to surrounding organs, nearly four in five cases are diagnosed at a late stage when the cancer is no longer curable. Today, just 17 per cent of women diagnosed with stage four ovarian cancer survive for five years or more.

The fallopian tubes are 10cm-long tubular ducts responsible for carrying eggs from the ovaries to the uterus. While 98 per cent of women will not develop ovarian cancer, the condition remains one of the most difficult cancers to detect early, leaving patients with few options beyond chemotherapy, which eventually stops working.

Origin of ovarian cancer in fallopian tubes

The push for routine tube removal follows two decades of groundbreaking research into how the disease develops. Dutch researchers initially posited the theory that ovarian cancer begins in the fallopian tubes rather than the ovaries after observing that precancerous cells were rarely present in the ovaries but were frequently found in the tubes. Although the theory was initially met with near-universal scepticism, subsequent major research trials proved the Dutch scientists right.

Studies revealed that nearly all ovarian cancers, including the vast majority of the most lethal variants, originate at the end of the fallopian tube. Microscopic cancerous cells float out from the tube and take root in an ovary. These early microscopic changes fail to appear on ultrasound scans or other medical imaging. A major British trial published in 2023 confirmed that screening methods, including blood tests and imaging scans, failed to spot the cancer early enough to save lives.

By removing the fallopian tubes before cancerous cells can reach the ovaries, doctors can cut the risk of deadly cancer by as much as 80 per cent. The remaining 20 per cent of cancers that do originate in the ovaries tend to be less lethal variants that are largely curable.

Preventative surgery for average-risk women

Current medical guidance already offers fallopian tube removal to high-risk women in the UK, but health bodies are now encouraging doctors to offer the procedure to women at average or low risk of the disease. Only women over 45 who no longer want or can have children are eligible for the procedure.

Dr Richard Edmondson, clinical professor in gynaecological oncology at the University of Manchester, emphasized the need to expand preventative care beyond genetic cases. "We know that around one in five cases of the most serious type of ovarian cancer will be related to a gene mutation or family history," Edmondson said. "But that's only 20 per cent. A wider strategy is needed to prevent that remaining 80 per cent of women deemed at average or low risk of ovarian cancer. Opportunistic salpingectomy is an important step in that process."

Edmondson added that any woman undergoing abdominal surgery where tube removal can be performed easily should be offered the option. "We've already established that removing a high-risk woman's fallopian tubes prevents the deadliest ovarian cancers," he said. "And research suggests the same is true for women at average or low risk of cancer. It seems a no-brainer, really."

In 2024, the British Gynaecological Cancer Society updated its guidance to recommend that opportunistic salpingectomy be considered during routine abdominal surgery for average-risk women who have finished having children. International organizations, including the International Federation of Gynaecology and Obstetrics and the European Society of Gynaecological Oncology, have also backed the procedure.

Comparing tube removal with ovary removal

For women at high genetic risk of ovarian cancer, such as those carrying BRCA1 or BRCA2 gene mutations, the gold-standard preventative treatment remains removing both the ovaries and fallopian tubes. While removing the ovaries reduces ovarian cancer risk by up to 95 per cent, it carries severe long-term health consequences for premenopausal women by triggering sudden early menopause.

Although hormone replacement therapy (HRT) can ease menopausal symptoms, the extended loss of protective oestrogen is linked to higher blood pressure, elevated cholesterol, an increased risk of memory loss and dementia in later life, and higher overall mortality rates. Removing only the fallopian tubes allows women to retain their ovaries and natural hormone production for longer.

Surgical risks associated with fallopian tube removal are generally low. Rare complications can include bleeding at the removal site, standard surgical infection risks, and accidental damage to nearby organs, including the ovaries.

The PROTECTOR trial and patient experiences

A UK research study called the PROTECTOR trial has been investigating the effectiveness of fallopian tube removal for the past eight years. The trial offers tube removal to premenopausal women at increased risk of ovarian cancer, allowing them to defer ovary removal until after natural menopause. Official results from the study are expected in about ten years, meaning official health service guidance still recommends removing both ovaries and tubes for high-risk patients.

Former EastEnders actress Kara Tointon, 43, chose to join the PROTECTOR trial after testing positive for the BRCA1 gene mutation in 2018 while pregnant with her first child. Tointon, known for her role on the BBC television soap opera, delayed surgical decisions until after the birth of her second son because she wanted to expand her family.

"It was my surgeon who recommended the PROTECTOR trial to me," Tointon said. "He gave me the option of removing my ovaries and starting on HRT. Then he mentioned that there was growing research to suggest that ovarian cancer was beginning in the fallopian tubes, and that by removing them and keeping an eye on things you could keep your ovaries for longer."

After discussing the options with her family, Tointon underwent the procedure in 2024. "At the time, losing my ovaries felt quite daunting," she said. "The surgery itself was so straightforward. I arrived in the morning and left that afternoon. I just have regular blood tests to look out for things at the moment."

Obstacles to widespread adoption

Despite growing professional support, doctors emphasize that patients must be thoroughly counselled before undergoing the procedure. Professor Adam Rosenthal, consultant gynaecologist at University College London Hospitals, noted that removing additional tissue carries potential risks. "When you remove more tissue, there can be a higher chance of bleeding or damage to other organs," Rosenthal said. "We also don't know enough yet about whether having the fallopian tubes removed can trigger earlier menopause in some women. But it's usually a very simple operation. As long as a woman has adequate information to help her decide whether it's the right thing to do for her, and no other medical problems that would make the surgery more dangerous, then it's usually a very easy thing to do that will statistically reduce her risk of ovarian cancer."

Other experts warn that the operation could create a false sense of security. Dr Elaine Leung, clinical lecturer in gynaecological oncology at the University of Birmingham, warned: "Even if you properly counsel patients, there's always the risk that if their tubes are removed, women may think they can never get ovarian cancer, which isn't true. As a result, they might be more likely to dismiss symptoms of the condition in the future, and delay treatment."

Professor Ranjit Manchanda, consultant gynaecological oncologist at Queen Mary University of London, who has spent 20 years researching ovarian cancer prevention and leads the PROTECTOR trial, noted that lack of awareness and surgical training remain barriers. "While many gynaecological surgeons will easily be able to do the procedure, doctors in other specialties may not," Manchanda explained.

Looking ahead, Manchanda emphasized that fallopian tube removal is only part of a broader strategy against rising cancer rates. "This is a huge and important finding. But we know that the number of cancer cases are only rising," Manchanda said. "At the moment, surgical intervention is the best way we know of to prevent ovarian cancer. But in the future we need to find better ways to identify women who are at high risk of the disease, and offer them more personalised care and prevention strategies."