{"entity":{"id":"idea-prev-opportunistic-salpingectomy-default","kind":"idea","name":"Remove the fallopian tubes during any pelvic surgery once childbearing is finished","aka":[],"tldr":"Most ovarian cancers start in the fallopian tubes. Removing the tubes at hysterectomy, or instead of tying them, as British Columbia has done, appears to prevent ovarian cancer.","summary":"Most ovarian cancers start in the fallopian tubes, so this idea makes salpingectomy the default at hysterectomy and in place of tubal ligation for permanent contraception in all health systems, once childbearing is finished. British Columbia's opportunistic salpingectomy programme shows reduced serous ovarian cancer incidence in early follow-up, there is no known effect on ovarian function, and salpingectomy is also a more effective sterilisation than ligation. The aim is fewer high-grade serous ovarian cancers in the exposed cohort. The test is registry-based cohort comparisons across adopting jurisdictions. Being tested at scale, it addresses the bottleneck Prevention we already have is not deployed and sits in the prevention and surgery sections.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Prevention we already have is not deployed): Islami et al., Proportion of cancer attributable to modifiable risk factors (CA 2018)","url":"https://doi.org/10.3322/caac.21440"}],"tags":[],"related":[],"cancers":["ovarian"],"sections":["prevention","surgery"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-prevention-adoption"],"keyPapers":["paper-islami-ca-cancer-j-clin"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Programme-wide opportunistic salpingectomy reduces high-grade serous ovarian cancer incidence by at least 40% in the exposed cohort at 15 years.","rationale":"Tubal origin of high-grade serous cancer; no known effect on ovarian function; salpingectomy is also a more effective sterilisation than ligation.","test":"Run registry-based cohort comparisons across adopting jurisdictions.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":8},"route":"/ideas/idea-prev-opportunistic-salpingectomy-default/","neighbours":{"cancer":[{"id":"ovarian","kind":"cancer","name":"Ovarian cancer","route":"/cancers/ovarian/"}],"section":[{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"bottleneck":[{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"}],"paper":[{"id":"paper-islami-ca-cancer-j-clin","kind":"paper","name":"Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States","route":"/key-papers/paper-islami-ca-cancer-j-clin/"}],"roadmap":[{"id":"prevention-roadmap","kind":"roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers","route":"/roadmaps/prevention-roadmap/"},{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"}]}}