What Is the Fallopian Tube?

The fallopian tubes are two narrow tubes, one on each side, connecting the ovaries to the uterus. Each month during ovulation, an egg released from the ovary travels through the fallopian tube toward the uterus. The tubes also play a central role in natural conception, as fertilisation typically occurs within the tube before the embryo travels to the uterus for implantation.

The fimbriated end of the fallopian tube, the fringe-like opening nearest to the ovary, is particularly significant in the context of cancer risk, as research has identified it as the likely origin point for many ovarian cancers.

What Is the Link Between the Fallopian Tubes and Ovarian Cancer?

For many years, ovarian cancer was assumed to originate in the ovary itself. Accumulating research has changed this understanding significantly. Studies now show that the most common and lethal type of ovarian cancer, high-grade serous carcinoma, is likely to begin in the fallopian tubes rather than the ovary.

Precancerous changes called serous tubal intraepithelial carcinomas (STICs) have been found in the fallopian tubes of women diagnosed with high-grade serous ovarian cancer, strongly supporting the tubal origin of this subtype. This discovery has opened a practical avenue for prevention: if many ovarian cancers start in the tubes, removing the tubes before cancer develops may prevent those cancers from forming.

What Is Risk-Reducing Salpingectomy?

Risk-reducing salpingectomy is the surgical removal of both fallopian tubes with the goal of reducing the risk of developing ovarian cancer. When performed during a separately planned abdominal or pelvic procedure, it is referred to as opportunistic salpingectomy.

The term “opportunistic” refers to the fact that the tube removal takes place at an opportune time, when a woman is already undergoing surgery for another reason. Rather than scheduling a standalone procedure purely for cancer prevention, the salpingectomy is added to an operation the woman would be having in any case. This approach keeps the additional surgical risk to a minimum while delivering meaningful long-term benefit.

Who Should Consider Risk-Reducing Salpingectomy?

Opportunistic salpingectomy is recommended for women at average risk of ovarian cancer who have completed their family and are already planning a pelvic or abdominal surgical procedure. Professional bodies including the Society of Gynecologic Oncology (SGO) and the American College of Obstetricians and Gynecologists (ACOG) both recommend that salpingectomy be discussed as an option in these circumstances.

You may wish to discuss salpingectomy with your gynaecologist if you:

• Are undergoing a caesarean section and do not plan further pregnancies
• Are planning a tubal ligation for permanent contraception and would consider tube removal as an alternative
• Have completed childbearing and are planning a hysterectomy, fibroid removal, or endometriosis surgery
• Are having other non-gynaecological abdominal surgery such as appendix removal or gallbladder surgery

Risk-Reducing Bilateral Salpingo-Oophorectomy (RRBSO) in High-Risk Women
(Can you see if this can be combined with the last section on high genetic risk)

Women with a known genetic predisposition to ovarian cancer, such as those carrying a BRCA1 or BRCA2 gene variant, have a substantially elevated lifetime risk of ovarian cancer and would benefit from more extensive risk management than opportunistic salpingectomy alone. Concurrent removal of both ovaries (RRBSO) is the gold standard in preventive surgical procedure in BRCA 1 or BRCA 2 gene carriers, and can reduce the lifetime risk of ovarian / fallopian tube cancers by 80-96%, together with a significant reduction in overall mortality.   

Women who have been diagnosed with hormone receptor-positive breast cancers can also benefit from removal of both fallopian tubes and ovaries (BSO).  As a permanent form of ovarian suppression, BSO removes the need for regular (often monthly) hormone suppression injections, and reduces the risk of breast cancer recurrence and ovarian cancers in these women.  

As RRBSO in these cases would often be performed as an elective standalone surgery, these women should undergo a comprehensive gynaecological review and consider holistic perspectives from both gynaecology and oncology.  

Minimally Invasive Surgery (MIS), also known as laparoscopic or keyhole surgery, is often possible for most cases of bilateral salpingo-oophorectomy, and significantly reduces pain, downtime / recovery, and scarring in these women.  

Which Surgeries Can an Opportunistic Salpingectomy be Combined With?

Opportunistic salpingectomy can be incorporated into a range of planned procedures, including:

• Hysterectomy (removal of the uterus) for any gynaecological indication, including fibroids, heavy bleeding, or endometriosis
• Laparoscopy for endometriosis or ovarian cysts, where minimally invasive instruments are already in use
• Tubal ligation, where the goal is permanent contraception. Tube removal achieves the same contraceptive outcome while also reducing ovarian cancer risk
• Caesarean section when the woman has decided she does not wish to conceive again
• Abdominal surgery for conditions such as appendicitis or gallbladder disease, where access to the pelvic area is already available

Not every abdominal procedure is appropriate for combining with salpingectomy. Your gynaecologist or surgeon will advise whether the specific procedure and your individual circumstances make it a suitable option.

What Are the Benefits?

The primary benefit of risk-reducing salpingectomy is a meaningful reduction in the risk of epithelial ovarian cancer, fallopian tube cancer, and peritoneal cancer, particularly the serous subtypes that account for the majority of ovarian cancer deaths.

Research demonstrates that:

• Removing the fallopian tubes during another surgery is safe and does not significantly add to the risk of the primary procedure
• Hospitals in Canada and parts of Europe have already adopted opportunistic salpingectomy as standard practice during relevant procedures
• A recent study found that one in four women diagnosed with aggressive ovarian cancer had undergone a previous pelvic surgery during which tube removal could have been offered

Because there is no reliable screening test for ovarian cancer, and because symptoms are often absent until late stages, surgical prevention represents one of the few concrete options available to women at average risk.

Does It Affect Hormones, Periods, or Fertility?

This is one of the most common questions women have, and the answers are reassuring for most:

Hormones: In opportunistic salpingectomy, only the tubes are removed. The ovaries are left in place. Since the ovaries produce oestrogen and progesterone, normal hormonal function continues after the procedure. There is no induced surgical menopause from salpingectomy alone.

Periods: Removing the fallopian tubes does not affect menstrual cycles. If the uterus is retained, periods will continue as before.

Fertility: The fallopian tubes carry eggs from the ovary to the uterus. Once both tubes are removed, conceiving naturally is no longer possible. Women who subsequently wish to conceive may consider in-vitro fertilization (IVF) in order to get pregnant.  Salpingectomy is therefore usually only recommended for women who are certain that they have completed their family.

There is some emerging evidence that salpingectomy may be associated with a slightly earlier onset of menopause in some women, though the reasons for this are not yet fully understood. This remains an area of ongoing research.

What Are the Limitations?

Risk-reducing salpingectomy is a significant but not absolute measure:

• It reduces the risk of the most common subtypes of epithelial ovarian cancer, particularly high-grade serous carcinoma, which has tubal origins. It will not prevent rarer ovarian cancer subtypes that originate within the ovary itself.
• It is not currently recommended as a standalone procedure for women at average risk who are not already planning surgery, as the risk-benefit balance of a separate operation does not justify it.
• It does not replace other aspects of gynaecological health monitoring. Regular check-ups, pap smear and cervical cancer screening, and prompt assessment of any new symptoms remain essential.
• Women with BRCA gene variants or a strong family history of ovarian cancer require a specialist conversation about a more comprehensive risk-reduction strategy, which may include risk-reducing bilateral salpingo-oophorectomy (removal of both tubes and ovaries) at an appropriate age.

What About Women at High Genetic Risk?

Women who carry a pathogenic variant in BRCA1 or BRCA2, or who have Lynch syndrome or other hereditary cancer syndromes, face a substantially higher lifetime risk of ovarian cancer and require a different approach.

For these women, the recommended standard is risk-reducing bilateral salpingo-oophorectomy, which involves removing both the fallopian tubes and the ovaries. This procedure is typically recommended between the ages of 35 and 45, depending on the specific gene variant and individual circumstances, and does induce surgical menopause.

Some centres are now exploring a staged approach for high-risk women, where the tubes are removed first (to provide partial protection) with oophorectomy planned for a later age. This approach is currently the subject of active clinical research. If you have a known hereditary risk, your gynaecologist should coordinate care with a genetic counsellor and gynaecological oncologist.

When to Speak to a Gynaecologist

You should raise the topic of salpingectomy with a gynaecologist in Singapore if:

• You are planning a hysterectomy, laparoscopic procedure, or other pelvic surgery and have completed your family
• You are considering tubal ligation and would like to understand whether tube removal is a better option for you
• You have a family history of ovarian cancer and are unsure what steps to take
• You carry a BRCA or other hereditary cancer gene variant and have not yet received specialist advice on surgical risk reduction

The conversation about salpingectomy is most productive before your planned surgery is scheduled, as it allows time to discuss the suitability of combining the procedures and to make an informed decision without time pressure. Managing conditions such as heavy periods or endometriosis that may be leading you toward surgery also creates a natural opportunity to ask about adding salpingectomy.