Ovarian cancer is often called a “silent” killer because it is usually caught late, when it is hard to treat. But a growing body of evidence points to a powerful, almost mundane way to prevent much of it — a small addition to surgeries people are already having. The problem is that many who could benefit are never offered it.

The key insight: it starts in the tubes

For decades, ovarian cancer was assumed to start in the ovaries. Research has since revealed that the majority of the most common and lethal form — high-grade serous cancer, which accounts for about 75% of epithelial ovarian cancers — actually appears to originate in the fallopian tubes, not the ovaries themselves. That shift in understanding changes the prevention playbook entirely: if the tubes are where the cancer begins, removing them could stop it before it starts.

What opportunistic salpingectomy is

The procedure is called opportunistic salpingectomy — removing the fallopian tubes while leaving the ovaries intact (preserving their hormone function), done as an add-on during another planned operation. Common opportunities include a hysterectomy, or in place of a tubal ligation for someone seeking permanent contraception. Because the ovaries stay, it doesn’t trigger surgical menopause. The evidence is compelling: one study found people who underwent the procedure were about 78% less likely to develop serous ovarian cancer than those who didn’t. Major bodies including the American College of Obstetricians and Gynecologists have endorsed it as a prevention strategy.

Where the gap is

Despite the evidence, access is uneven. The procedure is well established during gynecologic surgeries like hysterectomy, but it is often not offered during other abdominal operations where it could be done safely for people who have completed their families. Researchers have raised the possibility of extending it to settings like bariatric (weight-loss) surgery, cesarean section, or even non-gynecologic abdominal surgery such as gallbladder or appendix removal — procedures during which the surgeon is already operating in the region. Many patients simply never hear about the option.

Why it’s often out of reach

Several factors contribute: awareness (patients and even some clinicians may not know the tubes are the origin), coordination (adding a step requires the right specialists and consent in advance), surgical culture and time, and questions about reimbursement and who counts as a candidate. None of these are insurmountable — they are largely about implementation, not biology.

Why it matters

Ovarian cancer has stubbornly resisted early detection, so primary prevention is especially valuable. Opportunistic salpingectomy is a rare case where a low-risk, one-time addition to an operation someone is already having could meaningfully cut the odds of a lethal cancer. The message for people who have completed childbearing and are facing pelvic or abdominal surgery: it may be worth asking your surgeon whether removing the fallopian tubes is appropriate for you. This is educational information, not medical advice; discuss risks and eligibility with your doctor.