The American College of Obstetricians and Gynecologists (ACOG) has updated and strengthened its recommendation for salpingectomies for prevention of ovarian cancer on the basis of more evidence that these procedures provide substantial risk reduction.

The new guidance applies to women at average risk for ovarian cancer, separate from the guidance for those with a higher risk due to genetics, such as having a BRCA mutation or a family history.

“It’s critical that ob/gyns update themselves on the strength of the efficacy and safety data of salpingectomy and consider increasing the amount of times that they counsel patients about the opportunity to reduce the risk of ovarian cancer through removal of the fallopian tubes,” co-author of the guidance, David I. Shalowitz, MD, told Medscape Medical News.

“I think most ob/gyns are aware that there is a link between most ovarian cancers and the fallopian tubes, but the translation between that awareness and routine clinical practice potentially has been less clear, and I think the updated guidance really does solidify that in ways that that we hadn’t previously,” said Shalowitz, who is also a gynecologic oncologist and clinical associate professor at Western Michigan University Homer Stryker M.D. School of Medicine in Kalamazoo.

An estimated 20,890 cases of ovarian cancer occurred in the US in 2026, resulting in an estimated 12,730 deaths, but no screening method for the cancer currently exists.

“Unfortunately, what we see in practice is ovarian cancer is silent until it is symptomatic, and once it’s symptomatic, it’s often spread from the ovary into the intra-abdominal cavity,” Jordyn Silverstein, MD, medical gynecologic oncologist at UCLA, told Medscape Medical News. “At that point, most of the time, it’s not curable, so the best treatment is preventing it from ever happening.”

Most ovarian cancers start in the fallopian tubes before moving into the ovary, so removing them prevents the patient from developing ovarian cancer without losing their ovaries, which means avoiding premature menopause, she said.

The previous guidance from April 2019 advised ob/gyns to discuss with their patients whether to “consider” adding a salpingectomy to an already planned surgical procedure such as hysterectomy.

“The data were not mature at that time to support any stronger level of recommendation,” Shalowitz said. But with the additional evidence since then, the new guidance advises ob/gyns to “routinely perform bilateral salpingectomy at the time of hysterectomy.”

A 2016 meta-analysis of three studies that compared 3509 patients undergoing salpingectomy with 5,655,702 control individuals found a nearly 50% reduction in development of ovarian cancer (odds ratio, 0.51), a finding corroborated by a similar meta-analysis in 2025. Multiple other studies have found similar and even greater reductions, up to 78%, Shalowitz said.

Additions to Previous Guidance

For those seeking permanent contraception, the guidance advises complete, bilateral salpingectomy as the preferred tubal procedure instead of tubal ligation or partial salpingectomy. Though tubal ligation offers some risk reduction for endometrioid and clear cell cancers, leaving intact the tubal fimbriae, where high-grade serous ovarian carcinoma originates, means it’s less effective for prevention of this cancer.

The guidance also recommends complete salpingectomy be recommended to patients undergoing any non-hysterectomy gynecologic surgery that enters the peritoneal cavity as long as the patient does not desire future fertility.

“It’s incredibly important to remember that any surgical decision needs to be made in the context of shared decision-making between patients and physicians, but, that said, the practice update represents what ACOG believes should be the usual approach to providing care here,” Shalowitz said. “We don’t get the opportunity to substantially reduce the risk of a deadly cancer very often. It’s really important to take those opportunities as they come and ensure that patients have access to the procedure if they want it and it’s concordant with their values and goals for themselves.”

The guidance matches what many ob/gyns and gynecologic surgeons are already doing in clinical practice, but awareness is low outside the specialty, according to experts.

“I don’t think that the knowledge that salpingectomy has the potential to reduce ovarian cancer is widely known, so part of the battle here is reinforcing the burden of ovarian cancer…and then saying there is no better and safer way to reduce patients’ risks of getting this cancer, so we should all be working together to minimize patients’ chances of developing an ovary cancer,” Shalowitz said.

In fact, one of the notable changes to the guidance — and likely the most challenging to implement, experts say — is the recommendation that ob/gyns support other surgeons in offering salpingectomy at the same time as any abdominal surgery, such as bariatric surgery or gallbladder surgery, in patients who do not want future fertility.

That’s an area of “active national effort,” Shalowitz said, with ACOG working with the American College of Surgeons to identify the challenges of “expanding the procedural and counseling scope of surgeons who otherwise might not be doing gynecologic procedures,” he said.

Ritu Salani, MD, director of gynecologic oncology and professor of ob/gyn at UCLA, noted two big challenges to that effort: the counseling of patients and then the coordination of the surgical procedure.

“Is this something the surgeon feels comfortable doing, or is it going to require a gynecologist or gynecologic oncologist to come in and do that procedure, and then what is the coordination of care?” Salani said to Medscape Medical News. “So there’s a couple pieces that need to be smoothed out, but I definitely think it’s the next step.”

Silverstein agreed, noting that a gallbladder surgeon, for example, is not necessarily trained to think much about the gynecologic tract.

Adding salpingectomy to an otherwise indicated pelvic surgery adds an estimated 12-16 minutes to the procedure time without significantly changing the known operative and preoperative risks for any surgery. The biggest risk, Silverstein said, is that some blood supply is shared between the fallopian tubes, so removing them may cut off some blood supply to the ovaries.

“There have been studies showing that, after these opportunistic salpingectomies, a patient’s hormone levels go back to normal, so we are not inducing premature menopause in that moment,” Silverstein said. “But what we need to understand is longer-term follow-up to make sure that patients’ onset of menopause is not earlier than people who don’t get this procedure.”

Other research has found adding salpingectomy to preplanned surgeries for ovarian cancer prevention to be cost-effective as well.

One thing missing is further research “to ascertain benefits and harms of salpingectomy performed only as a standalone procedure for ovarian cancer risk reduction in average-risk patients,” the authors wrote.

Also, there isn’t a specific set of procedures that are better or worse candidates for offering patients the opportunity to have their fallopian tubes removed.

“We want to make sure patients are informed and feel empowered to” ask their gynecologists questions about salpingectomies, Shalowitz said.

Silverstein reported funding from Natera. Salani reported advisory board participation for Genmab, Merck, AbbVie, Whitehawk, Corcept Therapeutics, Daiichi Sankyo, and Eisai Co., Ltd. Shalowitz had no disclosures. 

Tara Haelle is a science/health journalist based in Dallas.