The American College of Obstetricians and Gynecologists (ACOG) has fortified its clinical guidelines, advising clinicians to routinely perform bilateral salpingectomies during hysterectomies and to collaborate with other surgical specialists to consider the procedure during nongynecologic operations. According to an ACOG press release, these updated recommendations reflect robust evidence supporting the removal of both fallopian tubes “as a safe and effective method of reducing patients’ lifetime risk of ovarian cancer.”

Sandra E. Brooks, MD, MBA, FACOG, chief executive officer of ACOG, emphasized the clinical necessity of this preventive approach: “Although advances in treatment have helped patients live longer, mortality from ovarian cancer remains high. Salpingectomy represents a meaningful opportunity to reduce a person’s risk of ever having to contend with this challenging disease.”

The impact of ovarian cancer in the United States remains severe. Data from ACOG outlines the high incidence and mortality rates estimated for 2025 (Table 1).

A major clinical hurdle in treating the disease is its insidious onset. ACOG noted that early clinical signs are frequently “vague — such as a feeling of abdominal fullness, changes in appetite and pelvic pain — which often contributes to delays in diagnosis.” Due to this lack of early, distinct symptomatology, ACOG stated, “Most patients are diagnosed when the disease has already spread to other organs, making successful treatment difficult.”

The revised guidance instructs obstetricians and gynecologists (OB/GYNs) to routinely conduct bilateral salpingectomies during a hysterectomy. Furthermore, the procedure should be offered to patients undergoing nonhysterectomy gynecologic surgeries that involve entering the peritoneal cavity, provided the patient does not desire future fertility.

Notably, ACOG’s previous stance dictated that a planned surgical route should not be altered strictly to facilitate a salpingectomy. Under the new guidance, clinicians are now encouraged to actively consider the feasibility and successful completion of a salpingectomy when counseling patients on possible or planned surgical routes. For patients seeking permanent sterilization, ACOG named complete, bilateral salpingectomy the preferred surgical approach “based on safety, efficacy and cancer risk reduction.”

A cornerstone of the updated guidelines is the push for interdisciplinary collaboration. ACOG urges OB/GYNs to advise and support colleagues in other surgical specialties, noting that “other non-gynecologic abdominal or pelvic surgeries may be good opportunities for patients to reduce their risk of ovarian cancer by choosing salpingectomy. Adding salpingectomy to other surgical procedures often incurs minimal risk to the patient while preventing them from needing another surgery.”

David Shalowitz, MD, MSHP, FACOG, a coauthor of the guidance, highlighted the importance of this multidisciplinary effort: “Obstetrician/gynecologists have an opportunity to empower patients through education, evidence-based practice and collaboration with other medical and surgical specialists. For now, salpingectomy is the safest, most effective way to prevent this deadly disease.”

Medical experts across gynecologic oncology have expressed strong support for the updated guidelines. Robert DeBernardo, MD, the Laura J. Fogarty Chair in Uterine Cancer Research at the Cleveland Clinic Lerner College of Medicine, characterized the ACOG guidance as “an excellent idea and supported by data demonstrating a reduction in ovarian cancer.”

He further elaborated on its practical application: “It is routinely being done at hysterectomy but would be offered to any women who has completed childbearing and having abdominal or pelvic surgery, for instance, her gallbladder removed.”

Susan C. Modesitt, MD, FACOG, FACS, the John D. Thompson Endowed Professor in Gynecologic Oncology at Emory University School of Medicine, outlined the potential epidemiological benefits and systemic challenges of widespread adoption (Table 2).

Modesitt suggested that the growing body of evidence should ideally motivate systemic changes in healthcare coverage. “As we get more of these data out to show what a long-term impact we could make in terms of reducing ovarian cancer burden, I think that healthcare payers and the government may be more willing to do these procedures in women at normal risk,” she said.

In a related statement, Matthew A. Powell, MD, of the Society of Gynecologic Oncology at Washington University School of Medicine, reiterated the vital importance of ACOG’s strengthened recommendation. He noted that while adoption is already high among OB/GYNs and gynecologic oncologists, broader awareness is necessary to ensure that other surgical specialists—such as urologists and colorectal surgeons—offer the procedure to appropriate patients during nongynecologic operations. Powell concluded that for patients with fallopian tubes who do not desire future fertility, salpingectomy is a highly effective, low-risk preventive measure that should be strongly considered during any pelvic surgery.