The American College of Obstetricians and Gynecologists (ACOG) has strengthened its clinical guidance to recommend bilateral salpingectomy—the removal of both fallopian tubes—during routine hysterectomies and other pelvic surgeries to significantly lower a patient’s lifetime risk of ovarian cancer, according to an update released by the organization.
Updated Guidance Prioritizes Fallopian Tube Removal for Ovarian Cancer Prevention
According to ACOG, robust data show that most ovarian cancers actually originate in the fallopian tubes rather than the ovaries themselves. Removing both tubes can reduce a patient’s lifetime risk of developing ovarian cancer by up to 78%, based on evidence cited in the updated recommendations. The National Cancer Institute estimated 20,890 new diagnoses and 12,730 deaths attributable to ovarian cancer in 2025. Because reliable early screening methods do not exist and symptoms like pelvic pain and abdominal fullness remain vague, most patients receive a diagnosis only after the disease has spread. Sandra E. Brooks, MD, MBA, FACOG, chief executive officer at ACOG, noted that while treatments have evolved, mortality rates stay high, making risk-reducing salpingectomy a vital preventative tool.
Surgical Opportunities and Shared Decision-Making Protocols
Under the revised guidelines, ob-gyns should routinely perform bilateral salpingectomy when patients undergo a hysterectomy. The update also advises that surgeons recommend the procedure to patients who do not want future fertility and are undergoing non-hysterectomy gynecologic procedures that enter the peritoneal cavity. Furthermore, ACOG changed its previous stance on surgical routes: clinicians should now consider the successful completion of salpingectomy when counseling patients on potential surgical approaches. For patients seeking permanent contraception, complete bilateral salpingectomy is now preferred over traditional tubal occlusion or partial removal due to superior cancer risk reduction and safety profiles. ACOG emphasizes that all choices must rely on informed consent and shared decision-making between the clinician and the patient.
Expanding Prevention Through Cross-Specialty Collaboration
The updated recommendations highlight the value of cross-specialty surgical teamwork. Non-gynecologic abdominal and pelvic procedures performed by other surgical specialists offer additional opportunities for patients to reduce their ovarian cancer risk. Adding salpingectomy to these operations often incurs minimal extra risk while sparing patients from requiring a secondary surgery later in life. ACOG encourages gynecologists to collaborate with other specialists to incorporate fallopian tube removal whenever appropriate and safe during abdominal exploration.