Illustration of ovarian cancer: © blueringmedia – stock.adobe.com
One-fourth of patients with high-grade serous carcinoma (HGSC) may have had their ovarian cancer prevented if they had received concurrent salpingectomy during an unrelated abdominal surgery, according to a retrospective analysis published in JAMA Surgery.1
Performing a salpingectomy, or the surgical removal of one or both fallopian tubes, at the time of another elective abdominal surgery is increasingly being explored as a prophylactic measure in individuals with at least an average life-time risk of developing ovarian cancer.1,2 The study defined “missed opportunities” for such procedures as the omission of a concurrent salpingectomy at any age in patients undergoing surgery resulting in permanent contraception (bilateral tubal ligation or hysterectomy), or at age 45 years or older in patients undergoing abdomino-pelvic surgery in cases when the salpingectomy would have been conducted 1 year or more prior to the HGSC diagnosis.
Among 1877 patients with HGSC included in the retrospective analysis, 23.7% (445 patients) had a missed opportunity for salpingectomy. Of these patients, over half (54.2%) had received a tubal ligation/hysterectomy. The other 45.8% had received other abdomino-pelvic surgeries, including cholecystectomy, hernia repair, and bowel surgeries.
The researchers also noted that among patients with an affected first-degree relative in the retrospective population, the chance for germline genetic testing and reflex risk-reducing surgery was missed in 43.2% of women.
As part of what the study authors described as their “mixed methods” research approach, they also administered an electronic survey to patients with HGSC who were part of a national ovarian cancer organization. Overall, 54 (15.5%) of 348 survey respondents reported having a missed opportunity for salpingectomy.
“A considerable proportion of patients with HGSC missed opportunities for risk assessment with genetic testing and for surgical prevention. Given the lack of effective screening and limited treatment options for HGSC, eradicating it requires addressing the full spectrum of missed opportunities,” first study author Sara Moufarrij, MD, a gynecologic oncology fellow in the Britta Weigelt Lab at Memorial Sloan Kettering Cancer Center, and coauthors wrote.
Patient Characteristics and Study Design
For the retrospective component of their study, the researchers reviewed data from 1877 patients with HGSC who were diagnosed and treated during the period from June 1, 2015, to June 1, 2021, at Memorial Sloan Kettering Cancer Center or Johns Hopkins.
The median age at ovarian cancer diagnosis was 64 years (range, 26-97) and the group was predominantly White (77.1%), with Black (8.3%) and Asian American and Pacific Islander (7.8%) individuals making up the next largest groups. Most patients were diagnosed at a late stage, with FIGO stage III (50.8%) and IV (38.9%) accounting for a combined 89.7% of cases. A minority of the cohort had a family history of ovarian cancer (13.3%) or breast cancer (37.1%).
Sixty-nine percent of the cohort tested negative for BRCA1/2 mutations, while 12% had no documentation of testing. The rates of patients with BRCA1 and BRCA2 mutations were 11% and 6%, respectively. Regarding other genetic mutations, ATM was the most frequently reported at 9%. Mixed mutations were found in 14% of the cohort, and other unspecified mutations were present in another 14%. At the time of data collection, 34.3% of patients had died.
Next Steps
Based on their findings, the researchers suggested the creation of a risk-assessment algorithm for prioritizing salpingectomy in appropriate patients.
“High-risk patients due to genetic susceptibility to ovarian cancer should be counseled and managed according to established guidelines. Patients with a family history of ovarian cancer and negative germline testing should have individualized counseling on available risk-reducing strategies including stand-alone salpingectomy For seemingly average-risk patients (negative germline testing and no family history), the option of post-reproductive OS at the time of other indicated operations should be maximized,” wrote Moufarrij et al.
References
1. Moufarrij S, Hazimeh D, Rockwell T, et al. Gauging the Magnitude of Missed Opportunity for Ovarian Cancer Prevention [published online August 13, 2025]. JAMA Surg. doi: 10.1001/jamasurg.2025.2810
2. McLoughlin K, Merritt MA. Opportunistic salpingectomy for prevention of ovarian cancer among the general population [published online July 22, 2025]. Curr Opin Obstet Gynecol. 2025. doi: 10.1097/GCO.0000000000001051