- •Who have completed childbearing, and
- •Who will undergo a gynaecologic procedure such as hysterectomy or permanent sterilization with the intention of leaving the ovaries in situ.
Benefits, Harms, and/or Costs
- 1.High-grade serous cancers of the ovary/fallopian tube/primary peritoneum account for approximately 70% of all epithelial cancers and differ from other epithelial cancers in their presentation, most prevalent stage, response to treatments, overall prognosis, and recurrence rates (High).
- 2.Fallopian tube cancers, previously believed to be quite rare, are high-grade serous cancers approximately 90% of the time and have identified precursor lesions (serous tubal intraepithelial carcinomas), whereas precursor lesions have not been identified on the epithelial surface of the ovary (High).
- 3.The recent change to the International Federation of Gynecology and Obstetrics staging system for high-grade serous cancers in 2014 included ovary, fallopian tube, and primary peritoneum together as primary sites of disease, reflecting the difficulty in distinguishing the location in which the cancer developed (High).
- 4.Prophylactic bilateral salpingo-oophorectomy can reduce the risk of high-grade serous cancers by 80% to 90% for breast cancer mutation carriers (High).
- 5.In women with breast cancer mutations, 5% to 6% of fallopian tubes from prophylactic salpingo-oophorectomies have serous tubal intraepithelial carcinomas present (High).
- 6.Serous tubal intraepithelial carcinomas are found most commonly at the fimbriated end of the fallopian tube and have p53 mutation changes identical to associated cancers (High).
- 7.Clear cell and endometrioid carcinomas are now believed to originate from endometriotic lesions deposited within the pelvis and around the ovary (High).
- 8.Oral contraceptive pill use effectively reduces the lifetime risk of developing an “ovarian” cancer by 50% when taken for more than 10 years (High).
- 9.Tubal ligation reduces the risk of endometrioid cancer by 52% and clear cell cancer by 48%, presumably by blocking retrograde menstruation and preventing endometriotic deposits within the pelvis. However, tubal ligation reduces the risk of developing high-grade serous cancers by only 19%, supporting the theory that these cancers arise within the distal end of the remaining fallopian tube (Moderate).
- 10.The strategy with greatest potential for risk reduction is bilateral salpingo-oophorectomy, which reduced the mortality rate from “ovarian” cancer in the Nurses' Health Study by 94%; however, the overall risk of death from any cause following bilateral salpingo-oophorectomy increased by 12%, reflecting the protective effect of estrogen in preventing cardiovascular disease before age 50 (High).
- 11.The effect of diet and obesity on “ovarian” cancer risk is currently unclear and requires further research (Low).
- 12.The role of metformin in the primary prevention of “ovarian” cancer needs further research for clarification (Low).
- 13.There is insufficient evidence to link the use of talc-containing products with “ovarian” cancer (Moderate).
- 14.Acetylsalicylic acid has been shown to reduce the risk of “ovarian” cancer, but the effect of non-acetylsalicylic acid, non-steroidal anti-inflammatory drugs and acetaminophen is unclear (Moderate).
- 15.There has been no effective screening protocol to date that can decrease mortality from “ovarian” cancer in the general population (Moderate).
- 16.There is no established link between the use of “ovulation stimulating drugs” and “ovarian” cancer (Moderate).
- 17.Treating endometriosis may reduce the risk of “ovarian” cancer (Low).
- 18.Performing opportunistic salpingectomy at the time of hysterectomy for benign gynaecologic disorders does not increase complication rates, length of hospital stay, or overall recovery time but does lead to a minor increase in surgical time (Moderate).
- 19.Retaining the fallopian tubes at the time of hysterectomy increases the risk of subsequent reoperation for tubal pathology (Moderate).
- 20.Population-based studies are required to evaluate whether opportunistic salpingectomy can reduce the incidence of high-grade serous cancers (Moderate).
- 1.The use of an oral contraceptive pill reduces the risk of users developing high-grade serous cancers and should be discussed when counselling women on contraceptive use (Strong, High).
- 2.When considering permanent contraception, tubal ligation is shown to have the additional benefit of reducing the risk of developing high-grade serous cancers. However, the fact that the complete removal of the fallopian tube may provide additional benefit should be discussed (Strong, High).
- 3.Removal of the ovaries in premenopausal women may increase the risk of cardiovascular disease and is not recommended without clinical indication (Strong, High).
- 4.Population-based screening should not be encouraged as a method of “ovarian” cancer risk reduction (Strong, High).
- 5.In considering hysterectomy with the ovaries remaining in situ, the fact that the removal of easily accessible fallopian tubes may reduce the risk of developing high-grade serous cancers without additional procedural risk, and is recommended, should be discussed (Strong, Moderate).
- 6.Prospective population-based surgical databases should be kept to monitor the effect of opportunistic salpingectomy on overall morbidity and mortality and especially the rates of high-grade serous cancers (Strong, Moderate).
Abbreviations:ASA (acetylsalicylic acid), BRCA (breast cancer), BTL (bilateral tubal ligation), CI (confidence interval), CS (Caesarean section), EOC (epithelial ovarian cancers), FIGO (International Federation of Gynecology and Obstetrics), HGSC (high-grade serous cancers), HR (hazard ratio), IVF (in vitro fertilization), OCP (oral contraceptive pill), OR (odds ratio), RR (relative risk), SEE-FIM (sectioning and extensively examining the fimbria), STIC (serous tubal intraepithelial carcinomas)
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Obstetrics and Gynaecology Canada
- Canadian Cancer Statistics 2015.Canadian Cancer Society, Toronto2015 (Available at:)https://www.cancer.ca/∼/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2015-EN.pdf(Accessed on January 2, 2017)
- Canadian Cancer Statistics 2014.Canadian Cancer Society, Toronto2014 (Available at:)http://www.cancer.ca/∼/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2014-EN.pdf(Accessed on January 2, 2017)
- The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory.Am J Surg Pathol. 2010; 34: 433-443
- GOC Statement Regarding Salpingectomy and Ovarian Cancer Prevention.2011 (Available at: https://g-o-c.org/wp-content/uploads/2015/09/7GOCStmt_2011Sep_SalpOvCa_EN.pdf. Accessed March 17, 2017.)
- Committee opinion no. 620: salpingectomy for ovarian cancer prevention.Obstet Gynecol. 2015; 125: 279-281
- SGO Clinical Practice Statement: Salpingectomy for Ovarian Cancer Prevention.Society of Gynecologic Oncology, Ottawa2013 (Available at:)https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention/(Accessed on January 2, 2017)
- Opportunistic salpingectomies for the prevention of a high-grade serous carcinoma: a statement by the Kommission Ovar of the AGO.Arch Gynecol Obstet. 2015; 292: 231-234
- Origin and molecular pathogenesis of ovarian high-grade serous carcinoma.Ann Oncol. 2013; 24: x16-x21
- Molecular abnormalities in ovarian cancer subtypes other than high-grade serous carcinoma.J Oncol. 2010; 2010: 740968
- Critical molecular abnormalities in high-grade serous carcinoma of the ovary.Expert Rev Mol Med. 2008; 10: e22
- Driver mutations in TP53 are ubiquitous in high grade serous carcinoma of the ovary.J Pathol. 2010; 221: 49-56
- BRCA1/2 mutations and expression: response to platinum chemotherapy in patients with advanced stage epithelial ovarian cancer.Gynecol Oncol. 2012; 125: 677-682
- Somatic mutations in BRCA1 and BRCA2 could expand the number of patients that benefit from poly (ADP ribose) polymerase inhibitors in ovarian cancer.J Clin Oncol. 2010; 28: 3570-3576
- BRCA1 and BRCA2 mutations correlate with TP53 abnormalities and presence of immune cell infiltrates in ovarian high-grade serous carcinoma.Mod Pathol. 2012; 25: 740-750
- Hereditary ovarian cancer.Hum Pathol. 2005; 36: 861-870
- Incessant ovulation—a factor in ovarian neoplasia?.Lancet. 1971; 2: 163
- Determinants of ovarian cancer risk. I. Reproductive experiences and family history.J Natl Cancer Inst. 1983; 71: 711-716
- Parity, tubal sterilization, hysterectomy and risk of primary fallopian tube carcinoma in Finland, 1975-2004.Int J Cancer. 2007; 120: 1351-1354
- Primary carcinoma of the fallopian tube.Obstet Gynecol Surv. 1961; 16: 209-226
- Carcinoma of the fallopian tube.Obstet Gynecol Surv. 1979; 34: 257-270
- Clues to the pathogenesis of fallopian tube carcinoma: a morphological and immunohistochemical case control study.Int J Gynecol Pathol. 2001; 20: 128-132
- 2014 FIGO staging for ovarian, fallopian tube and peritoneal cancer.Gynecol Oncol. 2014; 133: 401-404
- Assignment of primary site in high-grade serous tubal, ovarian and peritoneal carcinoma: a proposal.Histopathology. 2014; 65: 149-154
- Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: a systematic review to update the U.S. Preventive Services Task Force recommendation.Ann Intern Med. 2014; 160: 255-266
- Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers.J Natl Cancer Inst. 2009; 101: 80-87
- Clinical and pathologic findings of prophylactic salpingo-oophorectomies in 159 BRCA1 and BRCA2 carriers.Gynecol Oncol. 2006; 100: 58-64
- Pathologic findings in prophylactic oophorectomy specimens in high-risk women.Gynecol Oncol. 2002; 87: 52-56
- Clinical outcome of prophylactic oophorectomy in BRCA1/BRCA2 mutation carriers and events during follow-up.Br J Cancer. 2004; 90: 1492-1497
- Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction.J Clin Oncol. 2007; 25: 3985-3990
- BRCA-mutation-associated fallopian tube carcinoma: a distinct clinical phenotype?.Obstet Gynecol. 2005; 106: 1327-1334
- Risk-reducing salpingo-oophorectomy in BRCA mutation carriers: role of serial sectioning in the detection of occult malignancy.J Clin Oncol. 2005; 23: 127-132
- The tubal fimbria is a preferred site for early adenocarcinoma in women with familial ovarian cancer syndrome.Am J Surg Pathol. 2006; 30: 230-236
- Candidate serous cancer precursors in fallopian tube epithelium of BRCA1/2 mutation carriers.Mod Pathol. 2009; 22: 1133-1138
- Peritoneal carcinoma in women with genetic susceptibility: implications for Jewish populations.Fam Cancer. 2004; 3: 265-281
- Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: evidence for a causal relationship.Am J Surg Pathol. 2007; 31: 161-169
- Chromosomal instability in fallopian tube precursor lesions of serous carcinoma and frequent monoclonality of synchronous ovarian and fallopian tube mucosal serous carcinoma.Gynecol Oncol. 2008; 110: 408-417
- Serous tubal intraepithelial carcinoma localizes to the tubal-peritoneal junction: a pivotal clue to the site of origin of extrauterine high-grade serous carcinoma (ovarian cancer).Int J Gynecol Pathol. 2015; 34: 112-120
- Serous tubal intraepithelial carcinoma: its potential role in primary peritoneal serous carcinoma and serous cancer prevention.J Clin Oncol. 2008; 26: 4160-4165
- “Primary peritoneal” high-grade serous carcinoma is very likely metastatic from serous tubal intraepithelial carcinoma: assessing the new paradigm of ovarian and pelvic serous carcinogenesis and its implications for screening for ovarian cancer.Gynecol Oncol. 2011; 120: 470-473
- A candidate precursor to serous carcinoma that originates in the distal fallopian tube.J Pathol. 2007; 211: 26-35
- Serous carcinogenesis in the fallopian tube: a descriptive classification.Int J Gynecol Pathol. 2008; 27: 1-9
- Exposure of fallopian tube epithelium to follicular fluid mimics carcinogenic changes in precursor lesions of serous papillary carcinoma.Gynecol Oncol. 2014; 132: 322-327
- Incessant ovulation, inflammation and epithelial ovarian carcinogenesis: revisiting old hypotheses.Mol Cell Endocrinol. 2006; 247: 4-21
- Possible role of ovarian epithelial inflammation in ovarian cancer.J Natl Cancer Inst. 1999; 91: 1459-1467
- Fimbrial cells exposure to catalytic iron mimics carcinogenic changes.Int J Gynecol Cancer. 2015; 25: 389-398
- Salpingitis, salpingoliths, and serous tumors of the ovaries: is there a connection?.Int J Gynecol Pathol. 2002; 21: 101-107
- Chlamydia trachomatis and Mycoplasma genitalium plasma antibodies in relation to epithelial ovarian tumors.Infect Dis Obstet Gynecol. 2011; 2011: 824627
- Chlamydia trachomatis serology in women with and without ovarian cancer.Infect Dis Obstet Gynecol. 2008; 2008: 219672
- Tubal ligation and risk of ovarian cancer subtypes: a pooled analysis of case-control studies.Int J Epidemiol. 2013; 42: 579-589
- Molecular pathogenesis of endometriosis-associated clear cell carcinoma of the ovary (review).Oncol Rep. 2009; 22: 233-240
- Risk of developing ovarian cancer among women with ovarian endometrioma: a cohort study in Shizuoka, Japan.Int J Gynecol Cancer. 2007; 17: 37-43
- Panels of cytokines and other secretory proteins as potential biomarkers of ovarian endometriosis.J Mol Diagn. 2015; 17: 325-334
- Oral contraceptive use and impact of cumulative intake of estrogen and progestin on risk of ovarian cancer.Cancer Causes Control. 2013; 24: 2197-2206
- Oral contraceptive pills as primary prevention for ovarian cancer: a systematic review and meta-analysis.Obstet Gynecol. 2013; 122: 139-147
- Ovarian cancer risk factors by histologic subtypes in the NIH-AARP Diet and Health Study.Int J Cancer. 2012; 131: 938-948
- Tubal ligation and the risk of ovarian cancer: review and meta-analysis.Hum Reprod Update. 2011; 17: 55-67
- Tubal ligation, hysterectomy and epithelial ovarian cancer in the New England case-control study.Int J Cancer. 2013; 133: 2415-2421
- Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study.Obstet Gynecol. 2009; 113: 1027-1037
- Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis.Menopause. 2006; 13: 265-279
- Dietary intake and ovarian cancer risk: a systematic review.Cancer Epidemiol Biomarkers Prev. 2014; 23: 255-273
- Dietary fat intake and risk of epithelial ovarian cancer by tumour histology.Br J Cancer. 2014; 110: 1392-1401
- Preserved foods associated with increased risk of ovarian cancer.Gynecol Oncol. 2013; 129: 570-573
- Epithelial ovarian cancer and exposure to dietary nitrate and nitrite in the NIH-AARP Diet and Health Study.Eur J Cancer Prev. 2012; 21: 65-72
- Obesity and the risk of epithelial ovarian cancer: a systematic review and meta-analysis.Eur J Cancer. 2007; 43: 690-709
- Obesity and risk of ovarian cancer subtypes: evidence from the Ovarian Cancer Association Consortium.Endocr Relat Cancer. 2013; 20: 251-262
- Nutritional status, CT body composition measures and survival in ovarian cancer.Gynecol Oncol. 2013; 129: 548-553
- Old drug, new trick: repurposing metformin for gynecologic cancers?.Gynecol Oncol. 2014; 135: 614-621
- Metformin and gynecologic cancers.Obstet Gynecol Surv. 2014; 69: 477-489
- The effects of metformin on ovarian cancer: a systematic review.Int J Gynecol Cancer. 2013; 23: 1544-1551
- Genital powder use and risk of ovarian cancer: a pooled analysis of 8,525 cases and 9,859 controls.Cancer Prev Res (Phila). 2013; 6: 811-821
- Perineal talc use and ovarian cancer risk: a case study of scientific standards in environmental epidemiology.Eur J Cancer Prev. 2011; 20: 501-507
- Talc use and ovarian cancer: epidemiology between a rock and a hard place.J Natl Cancer Inst. 2014; : 106
- Perineal powder use and risk of ovarian cancer.J Natl Cancer Inst. 2014; : 106
- Aspirin in prevention of ovarian cancer: are we at the tipping point?.J Natl Cancer Inst. 2014; 106: djt453
- Aspirin, nonaspirin nonsteroidal anti-inflammatory drug, and acetaminophen use and risk of invasive epithelial ovarian cancer: a pooled analysis in the Ovarian Cancer Association Consortium.J Natl Cancer Inst. 2014; 106: djt431
- Prescription use of paracetamol and risk for ovarian cancer in Denmark.J Natl Cancer Inst. 2014; 106: dju111
- Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial.JAMA. 2011; 305: 2295-2303
- Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial.Lancet. 2016; 387: 945-956
- A randomized study of screening for ovarian cancer: a multicenter study in Japan.Int J Gynecol Cancer. 2008; 18: 414-420
- Use of fertility drugs and risk of ovarian cancer.Curr Opin Obstet Gynecol. 2014; 26: 125-129
- Ovulation-inducing drugs and ovarian cancer risk: results from an extended follow-up of a large United States infertility cohort.. 2013; 100: 1660-1666
- Fertility drug use and the risk of ovarian tumors in infertile women: a case-control study.Fertil Steril. 2013; 99: 2031-2036
- In vitro fertilization and risk of breast and gynecologic cancers: a retrospective cohort study within the Israeli Maccabi Healthcare Services.Fertil Steril. 2013; 99: 1189-1196
- Controlled ovarian hyperstimulation for IVF: impact on ovarian, endometrial and cervical cancer—a systematic review and meta-analysis.Hum Reprod Update. 2013; 19: 105-123
- New insights in the pathophysiology of ovarian cancer and implications for screening and prevention.Am J Obstet Gynecol. 2015; 213: 262-267
- Hormonal and surgical treatments for endometriosis and risk of epithelial ovarian cancer.Acta Obstet Gynecol Scand. 2013; 92: 546-554
- Success and complications of salpingectomy at the time of vaginal hysterectomy.J Minim Invasive Gynecol. 2015; 22: 864-869
- Postpartum permanent sterilization: could bilateral salpingectomy replace bilateral tubal ligation?.J Minim Invasive Gynecol. 2016; 23: 928-932
- Surgical outcomes and complications of prophylactic salpingectomy at the time of benign hysterectomy in premenopausal women.J Minim Invasive Gynecol. 2015; 22: 653-657
- Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: primum non nocere.Gynecol Oncol. 2013; 129: 448-451
- Prophylactic bilateral salpingectomy (PBS) to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy: complications and re-operation rate.J Cancer Res Clin Oncol. 2014; 140: 859-865
- Salpingectomy as standard at hysterectomy? A Danish cohort study, 1977-2010.BMJ Open. 2013; 3
- Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: A meta-analysis.Eur J Cancer. 2016; 55: 38-46
- Ovarian cancer risk after salpingectomy: a nationwide population-based study.J Natl Cancer Inst. 2015; : 107
- Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention.Am J Obstet Gynecol. 2014; 210: 471.e1-471.e11
This Clinical Practice Guideline has been prepared by the Society of Gynecologic Oncology of Canada (GOC) Guidelines Committee and reviewed by the Society of Obstetricians and Gynaecologists of Canada's Clinical Practice—Gynaecology, Medico-Legal, and Guideline Management and Oversight committees and approved by the Executive and Board of the Society of GOC and by the Board of the SOGC.
Disclosure statements have been received from all authors.