الفهرس 
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Abstract
Our understanding of the pathogenesis of ovarian cancer will be improved drastically with the understanding that HGSC can originate in the fallopian tube and, as a result, our approach to ovarian cancer prevention has fundamentally changed for women in the general population and is being challenged for women at high risk of developing the disease.
For women at population risk of ovarian cancer, opportunistic salpingectomy presents a promising approach to reducing incidence and mortality from ovarian cancer, and recommendations to integrate it into routine gynecologic practice are increasingly common.
While preliminary safety and efficacy data are very reassuring, there remain some unanswered questions. Specifically, we need more data on the impact of OS on ovarian function, which is being examined both through planned randomized controlled trials and a cohort study in BC in order to determine if OS accelerates menopause.
To be clear, we are not advocating surgical intervention solely for the purposes of salpingectomy nor change in surgical approach if the planned route for the required gynecologic surgery cannot achieve salpingectomy.
For women at high risk of ovarian cancer, such as women with germ line BRCA 1/2 mutations, who are advised to consider RRBSO from age 35, the possibility of ameliorating some of the effects of premature menopause by either bilateral salpingectomy alone or a staged approach of early bilateral salpingectomy followed by delayed bilateral oophorectomy closer to the age of natural menopause, is attractive. This two-staged approach appears to be most effective in terms of quality-adjusted life expectancy, and is cost-effective
Kwon JS, et al 2013
Although most BRCA-associated ovarian cancers likely arise in the fallopian tube, there are four important reasons why oophorectomy, either concurrent with bilateral salpingectomy or delayed, is still recommended in this population:
(1) Some of these cancers still appear to originate in the ovary,
(2) Oophorectomy prior to menopause is known to reduce breast cancer risk in this high-risk population by 50 % Rebbeck TR, et al 2009
(3) Even when incorporating the increased morbidity associated with surgical menopause, there is still a significant reduction in all-cause mortality associated with RRBSO among high-risk women, and
(4) While bilateral salpingectomy may reduce ovarian cancer risk, the degree of protective effect on ovarian cancer is unknown.
For these reasons we do not consider that it is yet appropriate to routinely advise young high-risk women (BRCA1 or 2 mutation carriers) to have bilateral salpingectomy as a prevention strategy either as a sole or staged procedure with a delayed oophorectomy; bilateral salpingo-oophorectomy on completion of childbearing still has to be the standard of care. However, bilateral salpingectomy may be an option for a well counseled woman if they are not yet prepared to undergo oophorectomy. ie, vs. no intervention at all.