Dozens of readers asked the same questions in response to my recent column about the practice of removing a woman’s fallopian tubes to prevent ovarian cancer: Why haven’t they heard about this before? And what needs to happen for doctors to offer the option more routinely?
I’m using this edition of The Checkup to dive further into the issue and answer reader questions.
Part of the reason people find the concept so surprising is because few doctors have caught on. Brian from Colorado, a family physician who has practiced for more than 30 years, said this was the first time he had heard of ovarian cancer starting in the fallopian tubes. He has referred countless patients for hernia repairs and gallbladder removals, during which the removal of fallopian tubes could be performed as an add-on procedure, but no surgeon had ever given his patients the option.
Joseph Sakran, a trauma surgeon at Johns Hopkins University, told me in an interview that he didn’t appreciate the potential of the procedure, called opportunistic salpingectomy, until a family member was diagnosed with ovarian cancer about six years ago. The experience prompted him to think about how he could use his background in surgery and public health to prevent the disease.
A study of ovarian cancer patients at his institution and Memorial Sloan Kettering, published last year in JAMA Surgery, found that about 1 in 4 women with ovarian cancer had previously undergone abdominal surgery. This was a huge missed opportunity: If fallopian tube removal had been offered at the time, it might have prevented their cancer from developing.
He believes making this add-on procedure standard practice will run into a few major barriers, but “none of them are scientific,” he said. The first is awareness. “Many surgeons outside of gynecology don’t even know it’s an option,” he said.
The second is training. Most general surgeons are not trained to remove fallopian tubes, so they would need to partner with gynecologists. Sakran described how this could work: A woman coming in for a hernia repair who doesn’t plan to have more kids could be given the option of the cancer-prevention surgery beforehand. If she wishes to have it done, the original surgery would proceed with the general surgeon repairing the hernia, then the gynecologist would step in to remove the tubes. This would take an extra five to 13 minutes, he estimated, with minimal additional risk.
Sakran hopes surgical training will eventually incorporate opportunistic salpingectomy into the curriculum because it is not a technically complicated procedure for surgeons already familiar with operating in the abdomen and pelvic regions. That would help ensure the procedure isn’t available only at academic medical centers where specialists can easily work together.
“Prevention has to reach the rural hospitals and safety net systems,” he said, not just well-insured, well-informed patients in major cities who know to ask for it.
The third barrier he identified, and one that many readers also flagged, is insurance coverage. Rebecca L. Stone, a gynecologic oncologist also at Johns Hopkins, said most private insurance plans do not cover fallopian tube removal for cancer prevention. She helped lead an overhaul of medical billing codes to create specific codes for preventive tube removal. The new codes took effect in October 2025 but most health plans have not yet incorporated them into coverage policies.
Miriam from California wrote that it shouldn’t be hard to convince insurers to cover the procedure. After all, ovarian cancer treatment can be very expensive. The problem, Stone explained, is that the insurer paying for prevention today may not be the same one paying for cancer treatment years later. She said insurers have questioned why they should cover it, since women who receive the procedure probably wouldn’t develop ovarian cancer until they are on Medicare.
She fears that unless that attitude changes, increasing awareness will only inform women about a way to prevent a lethal cancer that they cannot access. “And that’s just unconscionable to me,” she said.
“You talked about high-risk women with genetic mutations, but what about women like me who are higher risk but tested negative for BRCA?” asked Judy from Maryland. She wrote that her mother and grandmother died of ovarian cancer. “Should I get this procedure?”
Stone groups women into three categories: The first includes those at high risk because they have an identified genetic mutation. These patients are counseled to remove both their ovaries and fallopian tubes, though some may consider delaying ovary removal to avoid the health consequences of early menopause.
The second group includes women at average risk, who should be offered opportunistic fallopian tube removal as an add-on surgery to other planned procedures. The American College of Obstetricians & Gynecologists affirmed this in their recently revised guidelines.
Then there are women like Judy, who have no identified genetic mutation but are at elevated risk. “There are people who have buried their moms, their sisters, their aunts from tube ovarian cancer, and we know they’re at increased risk,” Stone said. “Those women really need to hear about the option of a stand-alone fallopian tube removal once they’re done having kids.”
Sandy from Michigan wanted to know why women should not remove their ovaries, too. “If a woman is already postmenopausal, why does she still need them?”
Stone said medical professionals have long made assumptions about ovaries that the evidence does not support. “We were taught in medicine that once the uterus stops bleeding every month, that your ovaries are dead and we don’t need them anymore. But that is totally made up,” she said.
Even after menopause, the ovaries continue producing hormones, and researchers do not fully understand their role as women age. Medicine, she said, has “disproportionately prioritized fertility over understanding and preserving ovarian endocrine health.”
That is one reason the shift toward fallopian tube removal is so important. It offers a way to reduce ovarian cancer risk while leaving the ovaries in place. “This is as much about preserving the ovary and preventing people from going into early menopause by losing their ovaries as it is about [cancer prevention] through tube removal,” Stone said.
It’s worth noting how much women’s health has been neglected. There is still much we don’t understand about women’s bodies, including the role of the ovaries throughout a woman’s lifespan.
But the science on fallopian tube removal as a cancer-preventive method is well-established. What’s needed now is to turn that lifesaving knowledge into standard practice.
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