David Shalowitz, MD, on strengthened evidence behind salpingectomy for ovarian cancer prevention

Robust new data on both the effectiveness and safety of bilateral salpingectomy in average-risk patients prompted ACOG's strengthened recommendation to perform the procedure during obstetric and gynecologic surgeries, according to David Shalowitz, MD, MSHP, Director, Cancer Care Delivery, Carewell Health, Grand Rapids, Michigan, and co-author of the update.

ACOG's clinical practice update, published August 25, 2026, in Obstetrics & Gynecology, recommends routine bilateral salpingectomy at the time of hysterectomy and other procedures, citing up to 78% ovarian cancer risk reduction. Full coverage of the update is available here.^1,2

Stronger evidence in average-risk patients

Shalowitz noted that the fallopian tube origin of most ovarian cancers has been established for years.

“Most ovarian cancers come from the fallopian tube, rather than the ovary itself. The vast majority of so-called ovarian cancers are of the high-grade serous carcinoma variety, and again, the pathology has shown us for many years that those cancers start in the fimbria of the fallopian tube,” he said.

What has changed, he explained, is the strength of the evidence for average-risk patients.

“Over the last several years, since the last publication of the committee statement on salpingectomy for reducing the risk of epithelial ovarian cancer, the data have gotten much stronger and more robust as far as the effectiveness of removing the fallopian tubes for preventing ovarian cancer in patients who have average risk for that disease, as well as the safety of the procedure,” he said.

He pointed to a British Columbia cohort as the strongest evidence to date.

“In that very large patient population, the relative risk reduction of developing an ovarian cancer later in life was 78%. So again, that's nearly an 80% reduction in the lifetime risk of developing an ovarian cancer in somebody who's at average risk,” Shalowitz said. Per the update, that cohort study reported a hazard ratio for serous ovarian cancer of 0.22 (95% CI, 0.05–0.95), among 40,527 patients who underwent salpingectomy compared with 45,296 who underwent a comparator surgery after a median follow-up of 4.7 years.^1,2

Weighing safety and surgical time

Shalowitz also emphasized the procedure's safety when added to another surgery.

“From an added operating room time perspective, the removal of the fallopian tubes generally adds 10 minutes or less to the total surgical time, and there is strong evidence of no additional surgical risk or perioperative risk,” he said, framing that reassurance within a shared decision-making process between patients and surgeons.

Given the consistency and quality of the data, Shalowitz said, “it was time to revise previous guidance to recommend more strongly that salpingectomy be recommended to patients when they're undergoing a number of obstetric and gynecologic procedures.” Per the update, ovarian cancer accounted for an estimated 20,890 cases and 12,730 deaths in 2025, with no effective screening currently available.

Reference:

1. Fitch J. ACOG clinical update recommends salpingectomy at time of hysterectomy. Contemporary OB/GYN. Published August 26, 2026. Accessed September 3, 2026. https://www.contemporaryobgyn.net/view/acog-clinical-update-salpingectomy-hysterectomy-ovarian-cancer-prevention
2. ACOG Committee on Clinical Consensus. Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention: clinical practice update. Obstet Gynecol. Published August 25, 2026.