Salpingectomy in individuals at high risk for tubo-ovarian cancer: consensus and precaution

Tubo-ovarian carcinoma, particularly high-grade serous carcinoma, is one of the most lethal gynecologic malignancies, largely due to its late-stage diagnosis and lack of effective screening strategies. For individuals with hereditary pathogenic variants in genes associated with ovarian cancer such as BRCA1, BRCA2, RAD51C, RAD51D, BRIP1, PALB2, and Lynch syndrome-associated genes, the National Comprehensive Cancer Network recommends risk-reducing salpingo-oophorectomy, which has been shown to decrease mortality. However, premenopausal oophorectomy can result in substantial quality-of-life impairments, and as a result, many high-risk individuals delay or forego risk-reducing salpingo-oophorectomy despite its proven mortality benefit. The discovery that most high-grade serous carcinomas originate in the fallopian tubes has led to interest in a novel preventive strategy: risk-reducing salpingectomy followed by delayed oophorectomy in high-risk individuals. In this clinical opinion, we describe that while risk-reducing salpingectomy with delayed oophorectomy has been associated with improved menopause-related quality of life and reduced cancer worry, its efficacy in cancer risk reduction has not been established. We explain the importance of offering risk-reducing salpingectomy with delayed oophorectomy within clinical trials whenever possible.