Prophylactic salpingectomy for the prevention of ovarian cancer: Who should we target?

Abstract

Ovarian cancer is the most fatal gynecologic malignancy (50% 5‐year survival) due to a typically advanced stage at diagnosis and a high rate of recurrence. Chemoprevention options are limited, and few interventions have been shown to reduce cancer risk or mortality. Emerging data support the model that fallopian tubes are the site of origin for a proportion of high‐grade serous cancers. This implies that a subset of cancers may be prevented by removing the fallopian tubes while leaving the ovaries intact. Accordingly, there has been shift in clinical practice for average risk women; some now recommend removal of both the fallopian tubes only instead of tubal ligation for sterilization or at the time of benign gynecologic surgery. This has been termed opportunistic salpingectomy and represents a means of decreasing the burden of ovarian cancer by preventing cancers that arise in the fallopian tubes. There have been no detailed, prospective reports that have estimated ovarian cancer risk reduction with opportunistic salpingectomy, neither among women at baseline population risk nor among women at a high risk of developing the disease. The situation is complicated for women with a BRCA mutation—bilateral salpingo‐oophorectomy is a proven means of risk reduction and salpingectomy alone is not the standard of care. Based on the existing data, salpingectomy alone should only be reserved for women with a lifetime risk of ovarian cancer of less than 5%.

Salpingectomía oportunista: Patrones de práctica en un grupo de ginecólogos colombianos

“…Para pacientes portadoras de mutaciones BRCA 1 y 2, sin embargo, el escenario es diferente. Mientras que la salpingo-ooforectomía es una práctica estandarizada y con alta evidencia para la reducción de riesgo de cáncer de ovario [24][25][26] , la salpingectomía como procedimiento único podría estar recomendada solamente para mujeres con un riesgo de vida de cáncer de ovario inferior al 5% o con historia familiar de este tipo de malignidad con paridad insatisfecha 27 .…”

Role of Routine Peritoneal Biopsies During Risk Reducing Salpingo-Oophorectomy (RRSO)

“…One third of all malignant neoplasms of the female genitals and half of all deaths from cancer are attributable to ovarian cancer (OC). The lifetime risk of OC is about 1 in 75 (cumulative risk to age 80 of 1.3 – 1.5%) 1 . Due to the fact that OC is mainly diagnosed only at an advanced stage (76% stage III/IV), 5-year survival rates are currently only 43% 2 , 3 .…”

“…Due to the fact that OC is mainly diagnosed only at an advanced stage (76% stage III/IV), 5-year survival rates are currently only 43% 2 , 3 . Among carriers of a pathogenic germline BRCA1 -mutation (gBRCA1) cumulative lifetime risks are estimated at 44 – 49%, gBRCA2 -mutations carriersʼ lifetime risks ranging between 17 to 21% 1 , 4 . Mutations in genes like PALB2, RAD51C/D, BRIP1 and the Hereditary Non-Polyposis Coli (HNPCC) genes (MLH1, MSH2, MSH6, PMS2) are responsible for less than 5% of the hereditary ovarian cancer but probably predispose to a lifetime risk of at least 5 – 11% 1 .…”

Adnexal mass: diagnosis and management

“…In women close to menopause, even with ovarian preservation, opportunistic salpingectomy has been increasingly recommended because of new concepts related to ovarian carcinogenesis. (29) High-grade serous carcinoma originates in the tubal epithelium. (30)(31)(32)(33) Most ovarian carcinomas occur in women over 50 years of age.…”