ACOG clinical update recommends salpingectomy at time of hysterectomy

This week, the American College of Obstetricians and Gynecologists (ACOG) issued updated guidance strengthening its recommendation that obstetrician-gynecologists perform bilateral salpingectomy at the time of hysterectomy and other surgical procedures as a strategy to reduce patients’ lifetime risk of ovarian cancer, following shared decision-making with patients.^1,2 The clinical practice update was published August 25, 2026, in Obstetrics & Gynecology.¹

The burden of ovarian cancer remains high, with an estimated 20,890 incident cases and 12,730 attributable deaths in 2025.^1,2

“Screening is ineffective for ovarian cancer, and the majority of new diagnoses are made in patients with metastatic disease. Furthermore, although recent advances in treatment have extended life expectancy, mortality is high and treatment is associated with substantial financial and psychosocial burdens for patients and their caregivers,” wrote the authors of the clinical practice update.¹

Symptoms of ovarian cancer, including abdominal fullness, changes in appetite, and pelvic pain, are often vague and contribute to delays in diagnosis.²

“Having cared for many women with ovarian cancer, I understand deeply the tremendous toll that complex surgery and multiple rounds of intensive chemotherapy can take on patients and their loved ones,” said Sandra E. Brooks, MD, MBA, FACOG, chief executive officer at ACOG. “Although advances in treatment have helped patients live longer, mortality from ovarian cancer remains high. Salpingectomy represents a meaningful opportunity to reduce a person’s risk of ever having to contend with this challenging disease.”²

What is the evidence base for salpingectomy as ovarian cancer prevention?

Robust pathologic and epidemiologic evidence supports the fallopian tube as the site of origin for most ovarian cancers, particularly high-grade serous ovarian carcinoma (HGSC), and removal of both fallopian tubes can reduce the risk of ovarian cancer by as much as 78%.²

The update cites various data points, including a 2016 meta-analysis of 3 studies involving 3509 patients who underwent salpingectomy and 5,655,702 who did not found an odds ratio (OR) of 0.51 (95% CI, 0.35–0.75) for subsequent development of ovarian cancer.¹ A subsequent meta-analysis through 2021 found similar results (OR 0.48; 95% CI, 0.33–0.69).

In 2026, a cohort study from British Columbia, Canada, found a hazard ratio for serous ovarian cancer of 0.22 (95% CI, 0.05–0.95) in 40,527 patients who underwent salpingectomy compared with 45,296 who underwent a comparator surgery after a median follow-up of 4.7 years.

Adding salpingectomy to an otherwise indicated pelvic surgery modestly increases operative time by 12 to 16 minutes without significantly increasing the risk of operative or perioperative complications.

What are the updated clinical recommendations?

ACOG’s updated guidance establishes 4 key recommendations:

• Obstetrician-gynecologists should routinely perform bilateral salpingectomy at the time of hysterectomy
• Bilateral salpingectomy should be recommended to patients undergoing nonhysterectomy gynecologic surgery that enters the peritoneal cavity who do not desire future fertility.
• Complete, bilateral salpingectomy is the preferred tubal procedure for patients desiring permanent contraception after shared decision making
• Obstetrician-gynecologists should support other surgical specialists in offering salpingectomy at the time of nongynecologic surgery by providing counseling and technical assistance as needed

Notably, the update reflects a change from prior ACOG guidance. Although ACOG previously recommended that the route of surgery should not be changed to facilitate salpingectomy, the updated guidance now recommends that obstetrician-gynecologists should consider successful completion of salpingectomy when counseling patients about potential surgical approaches, based on the strength of the body of supporting data.^1,2

According to ACOG, “This change is based on the strength of the body of data supporting salpingectomy to reduce the risk of ovarian cancer. The update emphasizes that all treatment decisions should be based on the principles of informed consent and shared decision making.”²

Why is cross-specialty collaboration highlighted?

The updated guidance specifically addresses the opportunity to expand salpingectomy to nongynecologic abdominopelvic procedures, offering patients an option to reduce ovarian cancer risk without requiring a separate surgery.^1,2 ACOG recommends that gynecologists collaborate with nongynecologic surgical specialists through training, intraoperative assistance, and joint patient counseling, modeled on existing cross-disciplinary relationships for cancer management.¹

“ACOG’s updated guidance represents the strongest recommendations to date supporting patients’ access to salpingectomy to reduce their lifetime risk of ovarian cancer,” said David Shalowitz, MD, MSHP, FACOG, co-author of the update. “Obstetrician-gynecologists have an opportunity to empower patients through education, evidence-based practice, and collaboration with other medical and surgical specialists. For now, salpingectomy is the safest, most effective way to prevent this deadly disease.”²

References:

1. ACOG Committee on Clinical Consensus. Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention: clinical practice update. Obstet Gynecol. Published August 25, 2026.
2. American College of Obstetricians and Gynecologists. ACOG strengthens recommendation for salpingectomy to reduce ovarian cancer risk. News release. Published August 25, 2026.