More Maryland hospitals are removing fallopian tubes to prevent cancer

When Christine Maple went to Greater Baltimore Medical Center in Towson recently to discuss fixing a hernia after her third and last child was born, her doctor steered the conversation unexpectedly toward ovarian cancer.

Maple didn’t have the disease or even a particular risk.

But the doctor asked: Would she want to remove her fallopian tubes to reduce her risk of the deadly cancer? It would likely add five minutes to the end of the hernia procedure, with little additional risk or recovery.

“I’m not one who ever thought I’d have an operation that isn’t necessary,” Maple said. “But I knew I was done having children, and I already had to have this operation anyway.

“I decided let’s knock this out at one time.”

Researchers discovered more than two decades ago that most ovarian cancer actually begins in the fallopian tubes, which serve as pathways for eggs from the ovaries to the uterus. More recent studies have shown that removing the tubes reduces the risk of disease by up to 80%.

More hospitals in Maryland are removing them when they perform another gynecological surgery, and at times when they perform any abdominal procedure. This reflects new guidance from the American College of Obstetricians & Gynecologists and other major medical associations.

But several local health providers say the rollout has been spotty and that few community hospitals perform “opportunistic salpingectomies” as routinely as GBMC, which developed a formal program last year. It pairs gynecological staff with general surgeons to make sure that people like Maple have the option.

There are about 20,000 new cases of ovarian cancer a year across the country. But there’s no general screening tool, no specific symptoms. That can make it especially difficult to diagnose and treat. It’s often only detected long after it’s spread.

While not the most common type of cancer, ovarian is among the most fatal. There are about 12,000 related deaths a year, and about half of people diagnosed don’t survive five years, according to the National Cancer Institute.

Dr. Rebecca Stone, a gynecological oncologist at Johns Hopkins Medicine, has been working with other groups to assess what women understand about risks of the cancer.

Stone said she has been struck by how little most know about the cancer and its link to fallopian tubes, a finding she said reveals how low a national priority women’s health issues have been.

Before the coalition behind Outsmart Ovarian Cancer began raising overall awareness, there was no other major public campaign to drive demand for salpingectomies.

Another reason for the lack of widespread adoption may be insurance. Stone said she helped push through a billing code for the procedure, but health plans have not adopted it. When the procedures are performed, they are typically labeled as sterilization because removing fallopian tubes prevents pregnancy.

Stone said that could be a barrier for older postmenopausal patients.

On that front, she is working with Maryland lawmakers to pass legislation requiring insurers in the state to cover the procedure at no cost to patients. It’ll be the third attempt when the General Assembly meets in January.

“It’s a lethal cancer for which there is no screening,” she said. “We need to support this change.”

Some community hospitals in Maryland say they offer tube removal to prevent cancer, sometimes in place of “tying tubes” to prevent further pregnancies or during a hysterectomy.

Some, including LifeBridge Health, which operates Sinai Hospital in Baltimore, offer the option of salpingectomies during both gynecological and other abdominal procedures such as gallbladder or appendix removal.

Maple, who lives in New Freedom, Pennsylvania, had worked at GBMC as a doula, which made her comfortable having the procedure there. After the salpingectomy, she enthusiastically spread the word.

Doctors, however, caution that it’s not for everyone because it means they can no longer become pregnant.

Dr. Shauna Costinett, Maple’s surgeon at GBMC, said the subject of childbearing can be sensitive. So can any hint that hospitals are involuntarily sterilizing patients, or that they are more often recommending the procedure to certain groups, such as people with disabilities or Black patients, given the nation’s history of medical mistreatment.

Costinett approaches with care and drops talk of the procedure if she hears or senses it’s unwelcome. If patients are interested, Costinett sets up a virtual meeting with gynecological staff to review individual risks and benefits.

Generally, Costinett said, tube removal is a simple and minimally invasive procedure and has no effect on menopause. That’s an issue with ovary removal, a step often taken when people test positive for certain genetic mutations linked to cancer.

Costinett said the conversations are beginning to feel more normal.

And she cites one particularly satisfying reason to keep talking about tubes: All material removed during the procedures goes under a microscope, and so far, they’ve seen some “early changes” that could have grown into cancer.

“The data globally shows we are reducing cancer with this procedure,” she said. “It’s very exciting to think we are seeing it in action.”