When the Supreme Court overturned federal abortion rights in the U.S. in June, Molly, a 38-year-old athletic trainer based in Ohio, made a medical decision that allowed her to take contraception into her own hands: She had an elective surgery that removed her fallopian tubes, a procedure known as a salpingectomy.
In the procedure, surgeons remove the tubes (as opposed to tying them, as with ligation), which connect the ovaries to the uterus; they leave the ovaries intact, able to keep producing hormones that bring many health benefits.
“The initial idea was a knee-jerk reaction to the Dobbs decision,” Molly (who requested that her last name be withheld for privacy) tells Yahoo Life. “I knew I was done having kids, and my spouse has two of his own — we’re done, we know that. But then, looking into it more, my OB talked a lot about how it also brought a reduced risk of ovarian cancer, and I was like, ‘This is a no-brainer.’”
Turns out Molly is far from alone in her thinking — as most recently evidenced by the sweeping recommendations of the Ovarian Cancer Research Alliance (OCRA), the leading ovarian cancer organization. Earlier this month the group urged genetic testing — as well as consideration of prophylactic fallopian tube removal not only for those who test and find they are high-risk, but also for all women planning to undergo another pelvic surgery (such as for hysterectomy, cysts and endometriosis), and if they are done with or not planning on having kids. A new initiative among five top cancer centers, Break Through Cancer, is also promoting the strategy.
The recommendation is the broadening of one that has prevailed for years, urging only women with high genetic risk, such as those who carry the BRCA1 or BRCA2 gene, to consider such a surgery. But ovarian cancer is the deadliest gynecologic cancer and the fifth leading cause of cancer deaths among U.S. women. And given that there is no reliable screening test for ovarian cancer — and that most of these cancers stealthily originate in the fallopian tubes — the new recommendations make more sense, say both OCRA and the Society of Gynecologic Oncology, which endorsed the move.
“There is currently no cure for the deadliest of all gynecological cancers, nor is there a way to screen for it that has any impact on mortality. But we know there is a way to dramatically reduce the risk,” Audra Moran, president and chief executive officer of OCRA, said in a press release about the new recommendations. They now replace decades of focusing on symptom awareness and early detection after a sobering U.K.-based clinical trial followed 200,000 women for more than 20 years and found that screening and symptom awareness does not save lives.
Those results, says Dr. Gillian Hanley, part of OCRA’s scientific advisory committee and an associate professor of obstetrics and gynecology at the University of British Columbia, “really suggest, pretty clearly, that messaging around symptom detection is not helpful — because those earlier-stage cancers would’ve been asymptomatic.”
But why is there still no reliable screening method for ovarian cancer? Hanley tells Yahoo Life nobody knows for certain, but that it could be because the fallopian tubes are not easily reached or biopsied — and that the type of lesion that precedes ovarian cancer, called a STIC (serous tubal intraepithelial carcinoma) lesion, starts in the fallopian tube.
“In order to find that lesion,” Hanley says, “you have to dissect and slice the fallopian tubes like crazy and look at them under a microscope. ... And then, even when found, it’s hard to treat.” It’s why she believes OCRA “very correctly identified” that prophylactic fallopian tube removal is what works best in preventing “high-grade ovarian cancers.” It’s an approach Hanley’s team has embraced since 2014, she says, with a high effectiveness rate, and also something that the American College of Obstetricians and Gynecologists (ACOG) has been endorsing since 2015.
But until this point, she explains, the recommendation “has largely been a physician and clinical care provided initiative.” And while it should be the provider who brings up the option, “it’s always useful to have the information in the patient’s hands as well,” she says. “There is no reason a patient can’t or should not go to their provider about this.”
Hanley is careful to clarify that what’s being recommended is an opportunistic salpingectomy, to be tacked on to another, already scheduled pelvic surgery. “We’re not recommending that every woman who finished childbearing have their tubes removed,” she stresses. “That would inundate ORs with salpingectomies.” Further, she says, ovarian cancer, while deadly, is “still rare, with a 1.4% over-a-lifetime risk.”
As Moran noted, “Ovarian cancer is considered a rare disease, but for those with a family history and/or genetic mutation, the risk jumps to 40-50% or even higher. So, knowing one’s risk level is critical.” That, combined with consideration of salpingectomy, she said, which could bring up to a 70% reduction of risk, are “our best weapons in this battle.”
Molly says hearing the latest news made her feel even better than she already did about her decision to have the surgery, which she says was a simple laparoscopic procedure that had her in and out of the hospital in about five hours — and back at work in about a week.
Others who have already gotten their tubes removed — either for contraception or to lower cancer risk, or both — give similar reports: that surgery was quick, simple and easy to recover from, leaving them with major peace of mind.
Firsthand experiences: ‘Saved my life.’ ‘It was super simple.’
A 52-year-old mother of two tells Yahoo Life she finally has peace of mind — but only after undergoing a preventative mastectomy and then a removal of her ovaries (oophorectomy) along with her fallopian tubes, after her mother was diagnosed with BRCA, prompting her to get tested too. She wound up being BRCA-positive, and called doctors “that day” to schedule preventative surgeries.
It wound up being a wise decision, as a postsurgery pathology report actually revealed the presence of “a microscopic cancerous cell” in the then-44-year-old’s fallopian tubes. That prompted rounds of chemotherapy and a full hysterectomy, which then sent her into menopause.
But the now cancer-free mom (who asked that her name be withheld for privacy) says that finding her cancer in a pathology report before it had the chance to spread made the surgeries worth it. It’s why she would encourage other women to consider the latest recommendations, saying, “Thank God I had surgery and saved my life.”
Nicole Garcia, 35, found herself in a similar situation five years ago: Her father had just been diagnosed with stage IV colon cancer, decades after his own mother died of breast cancer in her 50s. That prompted Garcia’s dad’s doctor to do genetic testing, revealing that he carried a BRCA gene — as did Garcia, she soon discovered.
Garcia had a preventative double mastectomy with reconstruction just a week before her dad died. And then she learned of all the other cancers she was at high risk of developing: ovarian, cervical, uterine, pancreatic, colon, stomach and melanoma. But it was the risk of ovarian cancer that most alarmed her, as she was “stunned” to learn there was no reliable screening method.
Her gynecologist suggested she get her fallopian tubes removed because of the known risk reduction and because unlike an oophorectomy, a salpingectomy would not interfere with menstruation or put Garcia into early menopause — and would preserve her ability to have a baby, albeit with IVF, in the future.
Though she says her entire abdominal area was “traumatized,” due to having fat grafts taken from her stomach for the reconstruction of her breasts, done at the same time as her salpingectomy, that was “mostly due to having the two surgeries,” Garcia tells Yahoo Life.
“I’m definitely in a better place now, thanks to therapy and processing it all,” Garcia says. “But I’m really glad the conversation has expanded, because it’s nice to have the agency to make these decisions but not for them to have to be so dramatically life-changing. I minimized my risk but still can decide about my ovaries, and if I want to have a family. So I am most thankful for the gift of time.”
Hanna Brooks Olsen, 35, meanwhile, approached her salpingectomy as a route to contraception. “I always knew I didn’t want kids,” the Portland, Ore., resident tells Yahoo Life. But doctors weren’t ready to trust her, as she was just 25 when she began searching for a surgeon to do what she had originally thought would be tubal ligation. She was 31 when she eventually found a surgeon to do the procedure — after four other doctors had turned her away.
“They were like, ‘Ask us in two more years,’ ‘Ask us at 30.’ ... They would come up with these arbitrary rules about when they were comfortable, or when they recommended it, and there was no reason besides this overwhelming paternalistic feeling of protecting me from making a bad choice,” Olsen says. “They’d say, ‘You’ll change your mind.’”
When Olsen finally did find a doctor who took her seriously, in Seattle, he was someone very up on the latest research regarding the prevention of ovarian cancer — which is why he recommended that she remove, rather than just tie, her tubes. “He had said, ‘This is where most of the literature is pointing,’” she says. “That’s why I did the recommended procedure.”
She recalls being in and out in less than five hours, and says she’s been left with just “two teeny tiny scars” from the laparoscopy, which she is “grateful” for.
“It was super simple,” says Olsen, who wrote about her story for Medium in 2019. “I’d never had surgery before, besides getting wisdom teeth out, so general anesthesia was pretty new for me. But I was impressed by the recovery time, how short it was: I was up and walking myself out to the car, and later I walked the dog. It was uncomfortable, but I wasn’t bedridden.”
Now, years later, she adds, “I think about it so little, which is a huge difference from how not being sterilized impacted my life ... when I was thinking about it all the time.”
The added bonus of a salpingectomy reducing cancer risk has only made Olsen feel more justified, even though she is BRCA-negative. “As I’ve gotten older, I’ve been thinking more and more about the history of cancer in my family,” she says. “And what most people don’t think about, and I certainly didn’t ... is the relation of fallopian tubes to cancer. So, to be informed that there was any sort of link was new information.”
The experience, Olsen recalls, “really drove home, for me, how little we are taught about our bodies ... how surface-level our knowledge of anatomy is.”
It’s why she recalls it being “awesome” that her surgeon showed her photos of her “innards” taken during the surgery — and that she briefly considered trying to keep her removed tubes in a jar, as a souvenir (her partner drew the line). But bottom line, Olsen says, “The difference for me in my life between tubal removal and ligation is none. ... I wasn’t, like, attached to keeping them in my body.”
Same goes for Savannah Blouin, 22, of Connecticut, who is also certain that she’ll never want to have kids — so certain, in fact, that she’s already had a salpingectomy.
She had planned to wait until she was 28 but “got it done so early because ... with the overturning of Roe v. Wade, I was concerned about trigger laws hindering the surgery in the future,” Blouin tells Yahoo Life.
“I had gone to my doctor asking for my tubes to be tied, and she told me that removing them will be a better option for me: Since I’m 22, the chance of my body regenerating and my tubes growing back together was too high for my comfort,” she says, noting that, unlike Olsen, she didn’t have trouble finding a doctor to comply with her wishes. “She also informed me of the recent discovery that ... ovarian cancer starts in the tubes, so if I’m not using them, it’s smart to take them out.”
Blouin now calls that reduced risk “a bonus perk” of the surgery, which “took 90 minutes” and was “largely laparoscopic,” with a small incision on each hip. The surgeon did, however, have to go in transvaginally in order to manipulate her uterus for clearer viewing during the procedure, she says.
“Recovery was easy,” she says, adding that “the most painful part was the intubation” but that “the pain and cramping only lasted about three days, and I was able to get through with very little use of the painkillers provided. I was back to work in a week.”
Also unlike Olsen, who left her fallopian tubes with the surgeon, Blouin fought to keep hers, and soon thereafter had them preserved in resin to be made into a necklace — something she shared on social media, landing her in the New York Post.
“I wanted to keep them and put them in jewelry because I thought it’d be funny, to be honest,” Blouin says about the surprisingly tiny, wormlike tubes. “My mom always joked about how she wished she made her fallopian tubes into earrings, so when I scheduled the surgery, I told my surgeon that’s exactly what I wanted to fulfill.”
Though her surgeon was “intrigued,” the hospital’s initial response was to say no, prompting her to learn the state laws allowing a surgery patient to keep specimens, and to write a letter to the hospital saying she’d pursue legal action if it wouldn’t hand her tubes over. Now, she says, wearing them makes her feel “empowered,” and she’s been vocal about her experience in the hopes of making others feel that way too.
“It’s well worth the surgery to have peace of mind, and never have to worry about a pregnancy scare again,” Blouin says, adding, “You can still get pregnant through IVF if you decide you want a biological pregnancy in the future. I see the surgery as low-risk, high-reward.”
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