Ovarian Cancer Might Not Start in the Ovary

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🧬 What if “ovarian cancer” doesn’t actually start in the ovaries?

That’s the revelation driving a quiet revolution in gynecology—and why a growing number of OB-GYNs are removing fallopian tubes instead of “tying” them.

This matters a lot, and most people don’t know it’s happening. Here’s what every woman deserves to understand about this critical shift in cancer prevention.

🔍 What’s going on?

Doctors have long referred to high-grade serous ovarian cancer as a deadly disease of the ovaries. But research shows that in most cases—up to 70%—these cancers actually begin in the fallopian tubes.

Now, more doctors are recommending opportunistic salpingectomy: removing the fallopian tubes during common procedures like tubal ligation or hysterectomy, even in women without a high genetic risk.

The goal? Prevent ovarian cancer before it starts.

🧠 Why is this happening?

• Decades of pathology studies have revealed that precancerous cells often develop in the fringed ends of the fallopian tubes, especially in women with BRCA mutations.

• These damaged cells can migrate to the ovaries, where they grow undetected until it’s too late.

• There’s no effective screening for ovarian cancer—no Pap smear, no mammogram equivalent. That makes prevention especially critical.

⚖️ What this means for patients & doctors

• Tubal removal is replacing tubal ligation: Instead of “tying” tubes, many doctors now remove them entirely. But not all providers explain the difference—and not all patients know what they’ve received.

• Insurance coding has lagged behind: Until now, there was no diagnostic code to specify salpingectomy for cancer prevention. That meant limited coverage, confusing records, and even denied claims.

• Some patients report unexpected side effects or find out later they had their tubes removed when they thought it was reversible.

• Others are deliberately asking for tube removal to reduce cancer risk—but are told it’s not covered unless coded a certain way.

✅ What’s changing now?

Thanks to advocacy from Dr. Rebecca Stone (Johns Hopkins) and others:

• New diagnostic codes are launching in October 2025 to clarify the “why” behind tube removal—especially for cancer prevention.

• This could improve insurance coverage, informed consent, and public understanding.

• Research from Canada and Sweden suggests salpingectomy may significantly reduce ovarian cancer risk—without triggering early menopause (which happens when the ovaries, not tubes, are removed).

💬 What this means for you

If you’re planning a hysterectomy or sterilization, or advising someone who is:

• Ask your doctor whether salpingectomy is appropriate, and whether they recommend removing tubes instead of ligating them.

• Clarify what’s being done—and whether it’s reversible.

• Push for full informed consent: You have a right to know what’s being removed and why.

References:

• Boodman, Eric To prevent ovarian cancers, fallopian tube removal is on the rise, STAT, 2025 June.

Resources:

• Listen to my interview with the Ovarian Cancer Research Alliance as we discuss why ovarian cancer is so hard to diagnose and why women are typically diagnosed in its later stages.

• Listen to my interview with Oriana Papin-Zoghbi about her company’s efforts to create an ovarian cancer diagnostic.

📩 Want to Help Change the Narrative?

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Let’s stop treating women’s health like charity. It matters and we need the attention and investment dollars to show this.