Salpingectomy in Ovarian Cancer Prevention
Efforts to develop screening for ovarian cancerhave been unsuccessful, in large part because of the uncertainty about the exact origin of the disease. For more than a century, physicians and scientists hypothesized that high grade serouscarcinoma arises from ovarian surface epithelium. However, accumulating epidemiological, clinical, pathological, and molecular data over the past 20 years indicate that high-grade serous carcinoma primarily originates from microscopic precancers in the fimbriated ends of fallopian tubes,ratherthan from the ovary itself. Unfortunately, the fallopian tube cannot be visualized using clinical-grade imaging, and there is no blood test to detect the early, yet rapidly spreading, peritoneal metastasis characteristic of high- grade serous carcinoma.
Since 2011,many national-level organizations world- wide have endorsed opportunistic salpingectomy as a practical, population-level approach to ovarian cancer prevention. Universal uptake of salpingectomy during hysterectomy and in lieu of tubal ligation could prevent nearly 2000 deaths from ovarian cancer per year and save a half billion healthcare dollars in the US annually. Given these potential benefits, opportunistic salpingectomy must become standard of surgical care, and efforts are needed to ensure tubal ligation and hysterectomy without salpingectomy for post reproductive women become obsolete.
Forging the standard of care for salpingectomy in ovarian cancer prevention will be a significant effort that requires radical collaboration between gynecologic and nongynecologic surgeons in ways that transform surgical culture. Knowledge translation must permeate the breadth of medicine and be unified across all sources that patients rely on for advice and referral. Expansion of opportunistic salpingectomy for the surgical prevention of ovarian cancer in the US will save lives, but to do so, adeptly overcoming the evident and unforeseen obstacles is mission critical.