A New Way to Prevent Ovarian Cancer Is Emerging. But It’s Often Out of Reach.

A consequential shift in our understanding of ovarian cancer has gone mainstream. Many of the deadliest cancers we call ovarian may actually begin in the fallopian tubes, and removing those tubes may dramatically reduce future cancer risk. The American College of Obstetricians and Gynecologists recently went as far as to recommend that ob/gyns routinely remove fallopian tubes during hysterectomy and non-ob/gyns consider opportunistic bilateral salpingectomy for patients undergoing other surgeries.

The momentum around this topic raises a harder question: How do we turn it into something patients can actually choose?

As a general surgery resident, I have learned how to remove an inflamed appendix, repair a hernia, and take out a diseased gallbladder. I now want to learn whether those same operations could also become opportunities to prevent cancer.

The operation, called opportunistic salpingectomy, involves removing both fallopian tubes during another abdominal surgery while leaving the ovaries in place. A study published this year found that patients who underwent opportunistic salpingectomy had nearly an 80% lower risk of serous ovarian cancer than patients who had hysterectomy or tubal ligation.

A 2025 study found something else that should get surgeons’ attention: Nearly one in four patients who later developed high-grade serous ovarian cancer had previously undergone abdominal surgery where salpingectomy could potentially have been included. Those operations included gallbladder, appendix, hernia, and bowel surgery.

These are operations general surgeons perform every day.

Gynecologists have been moving toward opportunistic salpingectomy for years. Now the conversation is reaching the rest of surgery. The American College of Surgeons has highlighted a potential role for general surgeons and reports that salpingectomy adds just 5 to 13 minutes to some abdominal operations.

So, I began working with colleagues in Surgery and Obstetrics and Gynecology at Duke, and at Washington University in St. Louis, to understand how general surgeons could offer this responsibly. What initially seemed like a question about learning a surgical technique quickly became a much larger question about implementation.

The opportunities are easy to imagine. A patient who has decided she no longer wants to have kids may be scheduled for gallbladder or hernia surgery. Why should she need another operation later if she wants her fallopian tubes removed? Or consider a patient who arrives with appendicitis and would like to reduce her future cancer risk. In theory, the same operation could treat today’s disease and help prevent tomorrow’s.

In reality, several roadblocks stand in the way.

One is consent. Federal Medicaid rules generally require at least 30 days between consent and a sterilization procedure, with limited exceptions. These protections exist for good reason. American medicine has a shameful history of coercive sterilization, and reproductive decisions must remain voluntary and informed.

But opportunistic salpingectomy now sits at a new intersection of cancer prevention and reproductive policy in ways that rules written decades ago were not designed to address. Federal agencies, professional societies, insurers, and patient advocates should develop clear national guidance for how cancer-prevention salpingectomy intersects with sterilization requirements while preserving strong protections against coercion.

Payment is another roadblock. A new diagnosis code identifies prophylactic fallopian-tube removal for ovarian-cancer prevention, yet insurance coverage has not necessarily followed. Insurers should establish clear policies so access to prevention does not depend on which insurance card a patient carries.

Hospitals also need systems to identify and counsel patients before they reach the operating room. Preoperative clinics could identify potentially eligible patients and connect those who are interested with counseling early enough to make an informed choice. Standardized educational materials could help ensure patients receive balanced information wherever they receive care.

Training must change, too. My gynecology colleagues tell me that, in appropriately selected patients, the operation itself is not especially challenging. But everything surrounding it, including who it should be offered to, how to counsel patients, how to protect fertility choices, and how to obtain the right consent, is currently outside my training.

There is no standard pathway for teaching general surgery residents to bridge that gap. There should be.

Surgical and gynecologic societies could develop joint curricula covering patient selection, counseling, operative technique, and complications, followed by competency-based credentialing for surgeons who want to offer the procedure. Research on implementation has already identified education, standardized counseling materials, and coordination between specialties as important facilitators.

None of this means salpingectomy should become a reflexive “while we are in there” procedure. It permanently eliminates natural conception. Consent must be informed and free of coercion. Surgeons must minimize additional risk, learn from gynecologists who perform the procedure routinely, and carefully study outcomes as implementation expands. Some patients will not be candidates. Others will not want it.

Those are reasons to expand this option carefully, not reasons to ignore the opportunity.

The science has moved quickly. This possibility has now been brought to a national audience. Now the harder work begins: removing the roadblocks between a promising cancer-prevention strategy and the patients who may one day want to choose it.

I chose to become a surgeon to treat disease. If an operation performed at the right time can also prevent a deadly cancer from ever developing, I want to learn how to offer it responsibly and help build the systems that make that choice possible.

These opinions are held by the author and do not represent any position held by the U.S. government, the Department of Veterans Affairs, or Duke University.