我从手术中醒来时昏昏沉沉，腹部多了三个小切口，内心却前所未有的平静。我刚刚通过腹腔镜切除了输卵管，因为这是对抗卵巢癌最佳，甚至可能是唯一的办法。卵巢癌很罕见，却是妇科最致命的癌症。
卵巢癌没法检测（有个常见的误解是巴氏涂片能检测，其实查的是宫颈癌）。主要原因在于最近发现的事实，约80%的卵巢癌起源于输卵管，而输卵管不易触及或活检。因此，癌症通常在扩散到输卵管外后才被发现，此时往往已是晚期，治疗难度大，治愈率仅为15%。
此外，卵巢癌及其癌前病变也无法通过血液检测发现。
2023年之前我也一无所知，后来我写了一篇关于卵巢癌研究联盟（OCRA）的建议才有所了解。当时研究联盟建议，不管风险高低，所有女性都应接受基因检测以了解患病风险，而且女性只要有机会都应考虑切除输卵管，即在接受其他腹部手术时预防性切除输卵管。
这一策略从2015年起就获得了美国妇产科医师学会（American College of Obstetrics & Gynecology）认可，被认为可将卵巢癌风险降低多达60%。推广的契机则是英国一项令人警醒的临床试验，试验跟踪了20万名女性超过20年，发现筛查和症状意识并不能挽救生命。
我曾患乳腺癌，一想到卵巢癌可能潜伏在我的输卵管中就会不寒而栗。所以，最近我做一次小型腹部手术时，毫不犹豫抓住机会切除了输卵管。
麻醉恢复期间，切口处的疼痛以及手术中医生为了便于操作注入腹部的气体让我不适了约一周，而内部愈合期间我一个月不能去健身房。但现在，我对自己的决定非常欣慰。
再看看加拿大温哥华市的最新研究结果，我心里更感宽慰。温哥华从2010年就开始向公众宣传预防性切除输卵管，并一直跟踪约8万名参与者，其中一半选择了手术另一半则没有。2024年3月，研究结果在美国癌症研究协会（American Association for Cancer Research）会议上公布，随后最近的妇科肿瘤学会（Society of Gynecologic Oncology）年会上再次提及。结果很明显，输卵管切除可将卵巢癌风险惊人地降低 80%。
“在医学领域，很少能将风险降低80%，”研究负责人，不列颠哥伦比亚大学（University of British Columbia）妇产科副教授吉莉安·汉利表示，“效果非常好。”
然而，为什么大多数女性对此一无所知？
让更多人知道输卵管切除
约翰霍普金斯医疗集团（Johns Hopkins Medicine）妇科肿瘤学家丽贝卡·斯通是宣传预防卵巢癌的领军人物。美国每年约有2万人被诊断患有卵巢癌，超过1.2万人因此死亡。看到这么多患者离世，这位外科医生夜不能寐。
2023年，英国令人沮丧的试验结果推动卵巢癌研究联盟等组织发布新建议并引起广泛关注，斯通才真正将推广输卵管切除当成使命。
“消息公布时，我心想，‘哦，太好了。谢天谢地。’但同时也感觉，‘准备还是不充分，’”斯通告诉《财富》。
主要原因是当时输卵管切除常规化的基础设施尚未完善，没有供女性在妇科诊所候诊时阅读的宣传资料，非妇科（甚至一些妇科）外科医生对该手术缺乏认知，甚至没有确保保险覆盖的专用计费代码。
就在同一时期，斯通获邀参加“突破癌症”（Break Through Cancer）科学咨询委员会的会议。“突破癌症”是一项由顶尖研究人员和医生合作预防和治疗最致命癌症的计划。当时有人问她知不知道如何治疗卵巢癌。
“我说，‘相信我，我一直在努力。有时很幸运，但多数时候只能眼睁睁看着病人去世，’”她说。“然后我说，‘但其实有办法如何预防。’”她回忆说，“当时，人们都震惊了。”连电话会议中顶尖的癌症专家也没听说过输卵管切除术的效果。
那场会议促成了“突破癌症”新倡议“拦截卵巢癌”，该倡议主要为了改善输卵管癌前病变的检测，将输卵管切除术作为预防手段向普通人群推广。斯通成功与美国疾病控制与预防中心(Centers for Disease Control and Prevention)合作创建了该项手术专用计费代码，还跟纪念斯隆·凯特琳癌症中心（Memorial Sloan Kettering）的妇科外科医生卡拉·朗联合发起“战胜卵巢癌”活动。
“还记得戒烟作为癌症预防策略时怎么向公众宣传的吗？记得那些广告牌和广告吗？我觉得现在就需要这样的宣传，”“突破癌症”总裁，癌症生物学家泰勒·杰克斯说。
“这是系统性问题，需要在医学界乃至更广泛范围进行真正的文化变革才能解决，”卵巢癌研究联盟主席兼首席执行官奥德拉·莫兰谈到输卵管切除术推广缓慢时表示。“这项手术还没被广泛采纳。”
确实，仍有一些障碍要克服，包括如何在一些有色人种社区提出这一敏感问题，因为历史上这类社区曾有强制绝育事件；如何说服一些外科医生相信手术效果，因为在温哥华研究结果之前，所有证据都基于历史数据；还有手术预防本身就容易让人望而却步。
不过斯通很快指出，另一种手术预防方法已被广泛接受。“就是结肠镜检查，”她说。“而且结肠镜检查的风险要高得多，”可能出现肠穿孔。“然后呢？5年或10年后还得再做一次。”斯通认为，输卵管切除一劳永逸，并且“从长远来看，成本更低”。
此外，汉利指出，“我们当然不是建议每个有输卵管的人都去做手术切除。永远不会主动推荐。这是外科干预手段，手术是有风险的。”但她认为这种方法“让人激动”，因为“多年来医学界一直缺乏不依赖生活方式的癌症预防手段，以往都是围绕饮食、运动、远离致癌环境等，其实都很难改变。”
你是否适合切除输卵管？
如果已经生育或没有生育计划，且即将接受其他腹部手术，如阑尾切除、胆囊切除、子宫切除等，就可以选择切除输卵管。
“我们真正想说的是，如果因为其他良性疾病要接受某种手术，并且已经安排好外科医生，强有力的证据表明，如果在其他手术中增加这一操作并不会增加额外风险，”汉利说。
如果没有其他手术计划仍想切除输卵管，可以选择作为绝育手段（替代输卵管结扎），从技术上讲，确实能达到绝育效果。
还有一些高风险人群，例如不到1%的携带BRCA1或BRCA2基因突变的人，卵巢癌风险会从1%上升到5%，“应该建议单独进行输卵管切除以降低风险，”斯通说。根据年龄不同，还可以考虑切除卵巢。
目前还不清楚输卵管切除的长期风险（如果有的话），但短期内没有风险，因为输卵管除了生殖功能外没有其他已知用途。这点与卵巢不同，卵巢在绝经后仍会分泌重要激素，她说。
我选择保留卵巢。但这些决定非常个人化。我从未想过自己会选择预防性手术，但数据说服了我。
至于斯通，她说自己在手术室里花了太多时间努力挽救“可怕疾病”的患者，正因如此，她绝不会放弃推广相关知识。
她说：“我会用余生每一分钟传播这些信息，尽可能让更多人知道。”（*）
译者：夏林
我从手术中醒来时昏昏沉沉，腹部多了三个小切口，内心却前所未有的平静。我刚刚通过腹腔镜切除了输卵管，因为这是对抗卵巢癌最佳，甚至可能是唯一的办法。卵巢癌很罕见，却是妇科最致命的癌症。
卵巢癌没法检测（有个常见的误解是巴氏涂片能检测，其实查的是宫颈癌）。主要原因在于最近发现的事实，约80%的卵巢癌起源于输卵管，而输卵管不易触及或活检。因此，癌症通常在扩散到输卵管外后才被发现，此时往往已是晚期，治疗难度大，治愈率仅为15%。
此外，卵巢癌及其癌前病变也无法通过血液检测发现。
2023年之前我也一无所知，后来我写了一篇关于卵巢癌研究联盟（OCRA）的建议才有所了解。当时研究联盟建议，不管风险高低，所有女性都应接受基因检测以了解患病风险，而且女性只要有机会都应考虑切除输卵管，即在接受其他腹部手术时预防性切除输卵管。
这一策略从2015年起就获得了美国妇产科医师学会（American College of Obstetrics & Gynecology）认可，被认为可将卵巢癌风险降低多达60%。推广的契机则是英国一项令人警醒的临床试验，试验跟踪了20万名女性超过20年，发现筛查和症状意识并不能挽救生命。
我曾患乳腺癌，一想到卵巢癌可能潜伏在我的输卵管中就会不寒而栗。所以，最近我做一次小型腹部手术时，毫不犹豫抓住机会切除了输卵管。
麻醉恢复期间，切口处的疼痛以及手术中医生为了便于操作注入腹部的气体让我不适了约一周，而内部愈合期间我一个月不能去健身房。但现在，我对自己的决定非常欣慰。
再看看加拿大温哥华市的最新研究结果，我心里更感宽慰。温哥华从2010年就开始向公众宣传预防性切除输卵管，并一直跟踪约8万名参与者，其中一半选择了手术另一半则没有。2024年3月，研究结果在美国癌症研究协会（American Association for Cancer Research）会议上公布，随后最近的妇科肿瘤学会（Society of Gynecologic Oncology）年会上再次提及。结果很明显，输卵管切除可将卵巢癌风险惊人地降低 80%。
“在医学领域，很少能将风险降低80%，”研究负责人，不列颠哥伦比亚大学（University of British Columbia）妇产科副教授吉莉安·汉利表示，“效果非常好。”
然而，为什么大多数女性对此一无所知？
让更多人知道输卵管切除
约翰霍普金斯医疗集团（Johns Hopkins Medicine）妇科肿瘤学家丽贝卡·斯通是宣传预防卵巢癌的领军人物。美国每年约有2万人被诊断患有卵巢癌，超过1.2万人因此死亡。看到这么多患者离世，这位外科医生夜不能寐。
2023年，英国令人沮丧的试验结果推动卵巢癌研究联盟等组织发布新建议并引起广泛关注，斯通才真正将推广输卵管切除当成使命。
“消息公布时，我心想，‘哦，太好了。谢天谢地。’但同时也感觉，‘准备还是不充分，’”斯通告诉《财富》。
主要原因是当时输卵管切除常规化的基础设施尚未完善，没有供女性在妇科诊所候诊时阅读的宣传资料，非妇科（甚至一些妇科）外科医生对该手术缺乏认知，甚至没有确保保险覆盖的专用计费代码。
就在同一时期，斯通获邀参加“突破癌症”（Break Through Cancer）科学咨询委员会的会议。“突破癌症”是一项由顶尖研究人员和医生合作预防和治疗最致命癌症的计划。当时有人问她知不知道如何治疗卵巢癌。
“我说，‘相信我，我一直在努力。有时很幸运，但多数时候只能眼睁睁看着病人去世，’”她说。“然后我说，‘但其实有办法如何预防。’”她回忆说，“当时，人们都震惊了。”连电话会议中顶尖的癌症专家也没听说过输卵管切除术的效果。
那场会议促成了“突破癌症”新倡议“拦截卵巢癌”，该倡议主要为了改善输卵管癌前病变的检测，将输卵管切除术作为预防手段向普通人群推广。斯通成功与美国疾病控制与预防中心(Centers for Disease Control and Prevention)合作创建了该项手术专用计费代码，还跟纪念斯隆·凯特琳癌症中心（Memorial Sloan Kettering）的妇科外科医生卡拉·朗联合发起“战胜卵巢癌”活动。
“还记得戒烟作为癌症预防策略时怎么向公众宣传的吗？记得那些广告牌和广告吗？我觉得现在就需要这样的宣传，”“突破癌症”总裁，癌症生物学家泰勒·杰克斯说。
“这是系统性问题，需要在医学界乃至更广泛范围进行真正的文化变革才能解决，”卵巢癌研究联盟主席兼首席执行官奥德拉·莫兰谈到输卵管切除术推广缓慢时表示。“这项手术还没被广泛采纳。”
确实，仍有一些障碍要克服，包括如何在一些有色人种社区提出这一敏感问题，因为历史上这类社区曾有强制绝育事件；如何说服一些外科医生相信手术效果，因为在温哥华研究结果之前，所有证据都基于历史数据；还有手术预防本身就容易让人望而却步。
不过斯通很快指出，另一种手术预防方法已被广泛接受。“就是结肠镜检查，”她说。“而且结肠镜检查的风险要高得多，”可能出现肠穿孔。“然后呢？5年或10年后还得再做一次。”斯通认为，输卵管切除一劳永逸，并且“从长远来看，成本更低”。
此外，汉利指出，“我们当然不是建议每个有输卵管的人都去做手术切除。永远不会主动推荐。这是外科干预手段，手术是有风险的。”但她认为这种方法“让人激动”，因为“多年来医学界一直缺乏不依赖生活方式的癌症预防手段，以往都是围绕饮食、运动、远离致癌环境等，其实都很难改变。”
你是否适合切除输卵管？
如果已经生育或没有生育计划，且即将接受其他腹部手术，如阑尾切除、胆囊切除、子宫切除等，就可以选择切除输卵管。
“我们真正想说的是，如果因为其他良性疾病要接受某种手术，并且已经安排好外科医生，强有力的证据表明，如果在其他手术中增加这一操作并不会增加额外风险，”汉利说。
如果没有其他手术计划仍想切除输卵管，可以选择作为绝育手段（替代输卵管结扎），从技术上讲，确实能达到绝育效果。
还有一些高风险人群，例如不到1%的携带BRCA1或BRCA2基因突变的人，卵巢癌风险会从1%上升到5%，“应该建议单独进行输卵管切除以降低风险，”斯通说。根据年龄不同，还可以考虑切除卵巢。
目前还不清楚输卵管切除的长期风险（如果有的话），但短期内没有风险，因为输卵管除了生殖功能外没有其他已知用途。这点与卵巢不同，卵巢在绝经后仍会分泌重要激素，她说。
我选择保留卵巢。但这些决定非常个人化。我从未想过自己会选择预防性手术，但数据说服了我。
至于斯通，她说自己在手术室里花了太多时间努力挽救“可怕疾病”的患者，正因如此，她绝不会放弃推广相关知识。
她说：“我会用余生每一分钟传播这些信息，尽可能让更多人知道。”（*）
译者：夏林
I woke up from surgery groggy, with three minuscule incisions in my abdomen and huge peace of mind. I’d just had my fallopian tubes laparoscopically removed, as it’s the best—and possibly only—defense against ovarian cancer, which, though rare, is the most lethal gynecological cancer there is.
There is no detection method for ovarian cancer (a common misunderstanding is that it’s the Pap smear, but that’s for cervical cancer). That’s largely because of something discovered relatively recently: About 80% of the time, cancer of the ovaries forms in the fallopian tubes, which are not easily reached or biopsied. So the cancer is not found until it spreads beyond the tubes, by which point it has typically reached a later stage and is harder to treat, with cure rates as low as 15%.
The cancer and its pre-cancer lesions are also not detectable through blood tests.
I myself had no idea about any of this until 2023, when I wrote about the Ovarian Cancer Research Alliance (OCRA) making sweeping recommendations: that all women get genetically tested to know their risk of the disease, and that all women, regardless of their risk factor, consider having what’s called an opportunistic salpingectomy—the prophylactic removal of fallopian tubes if and when they are already having another abdominal surgery.
The strategy—endorsed by the American College of Obstetrics & Gynecology since 2015—was believed to cut down the risk of ovarian cancer by up to 60%. It was adopted as a wide recommendation after a sobering U.K.-based clinical trial followed 200,000 women for more than 20 years and found that screening and symptom awareness do not save lives.
As a breast cancer survivor, the idea of ovarian cancer possibly hanging out in my fallopian tubes was haunting. So when I had the opportunity to get them removed during a recent minor abdominal surgery, I seized it.
Recovery from the anesthesia—along with incision-site soreness and uncomfortable bloating from the gas the surgeon pumped into my belly so she could see her way around—slowed me down for about a week, while waiting for the internal healing kept me out of the gym for a month. But now I feel incredibly relieved about my decision.
That’s especially true in light of major new findings out of Vancouver, British Columbia, which started a public campaign about prophylactic salpingectomy in 2010 and has been following about 80,000 people—half who opted for the procedure and half who did not—ever since. The results, announced in March 2024 at a meeting of the American Association for Cancer Research and again at a recent annual meeting of the Society of Gynecologic Oncology, were major: that salpingectomy cuts down one’s risk of ovarian cancer by a staggering 80%.
“There’s very little in medicine that gets you an 80% risk reduction,” says study lead Gillian Hanley, associate professor of obstetrics and gynecology at the University of British Columbia. “It’s remarkable.”
So why don’t more women know about it?
The effort to raise awareness of opportunistic salpingectomy
Dr. Rebecca Stone, a gynecologic oncologist at Johns Hopkins Medicine, is a leader in the effort to get the word out about preventing ovarian cancer—diagnosed in about 20,000 Americans a year and killing over 12,000. Seeing so many patients die was something that kept the surgeon awake at night.
She began to truly make opportunistic salpingectomy her mission starting in 2023, when the dismal U.K. trial results prompted organizations like OCRA to make headlines with the new recommendations.
“When all that came out, I was like, ‘Oh, great. Thank God.’ But I was also like, ‘We’re not ready yet,’” Stone tells Fortune.
That’s because there was no infrastructure around making salpingectomy the norm—no educational materials for women to leaf through while waiting at the gynecologist’s office, no awareness among non-gynecological (and even some gynecological) surgeons about offering the procedure, and not even any billing codes that would make insurance coverage for the procedure possible.
Around the same time, Stone was asked to join a meeting of the scientific advisory board for Break Through Cancer, a collaborative effort among top researchers and physicians to prevent and cure the deadliest cancers. Someone asked her if she knew how to cure ovarian cancer.
“I was like, ‘Believe me, I’ve been trying. Sometimes we get lucky, but most of the time I bury my patients,’” she says. “And then I said, ‘But we do know how to prevent it.’” At that, she recalls, “People’s hair blew back.” Not even the top cancer minds on the call had heard about the effectiveness of salpingectomy.
That call led to the creation of a new Break Through Cancer initiative, Intercepting Ovarian Cancer, which aims to both improve detection of fallopian tube pre-cancers and to expand salpingectomy as a prevention tool within the general population. Stone has already succeeded in working with the Centers for Disease Control and Prevention to create specific billing codes for the procedure, and is now gearing up to launch the Outsmart Ovarian Cancer Campaign with Memorial Sloan Kettering gynecologic surgeon Dr. Kara Long.
“Remember when smoking cessation was a cancer prevention strategy that people got behind? The billboards and advertisements? That is, I think, what we need here,” says cancer biologist Tyler Jacks, Break Through Cancer’s president.
“This is a systemic problem that will take true cultural change within the medical community and beyond to solve,” adds OCRA president and CEO Audra Moran about the slow adoption of salpingectomy. “We know it’s not being adopted as widely as it could be.”
Indeed, there are still barriers to the effort—including how to present the issue with sensitivity in some communities of color, which carry the historic U.S. burden of coercive sterilization; convincing some surgeons that there is enough evidence behind it, as all of it up until the Vancouver findings has been based on historic data; and also the idea of surgical prevention itself, which can be off-putting.
But there is another surgical prevention embraced as the norm, Stone is quick to point out. “It’s called a colonoscopy,” she says. “And the risks of the colonoscopy are much higher,” including the possibility of bowel perforation. “And then, guess what? You have to do it all again in five or 10 years.” Salpingectomy, she argues, is a one-and-done, and is “much more cost-saving” in the long run.
Plus, notes Hanley, “of course, we are not suggesting that every person with fallopian tubes needs to go and have them surgically removed. That will never be the recommendation. It is a surgical intervention, and surgery is not without risk.” But she does see the approach as “exciting,” as, “for so many years, we have not had a lot of cancer prevention that was not lifestyle-focused—revolving around diet, exercise, environmental exposure to carcinogens, and things that are really challenging to change.”
Is salpingectomy right for you?
Anyone finished having children or not planning on having children who is already going to have another abdominal surgery—appendectomy, gallbladder removal, hysterectomy, for example—is a candidate for opportunistic salpingectomy.
“What we’re really saying is that if you are already having some kind of a surgery, because of some other benign disease that you’re treating, and the surgeon is there already, we have really compelling evidence that adding this to another procedure does not change your risks at all compared to what you would already risk with surgery,” Hanley says.
If you’re not having another surgery and really want your fallopian tubes removed anyway, you could opt to do it as a route to sterilization (instead of tubal ligation), which it technically is.
Women at high risk—such as the less than 1% who have a genetic mutation such as BRCA1 or BRCA2, which raises the risk of ovarian cancer from 1% to 5%—“should be recommended a stand-alone salpingectomy for risk reduction,” says Stone. They might also consider an oophorectomy—removal of the ovaries—depending on their age, she adds.
While the long-term risks of salpingectomy, if any, are not known, there are no short-term risks, as fallopian tubes don’t serve any known purpose beyond reproduction—as opposed to the ovaries, which still produce important hormones likely well beyond menopause, she says.
I opted to keep my ovaries. But these decisions are, of course, highly personal. I never thought I’d be someone to get elective surgery in the first place, but the statistics convinced me.
As for Stone, she says she has spent too many hours in the operating room trying to save patients “with this horrible disease” to give up on awareness.
“I am going to spend every minute of my remaining life to get this information out there,” she says, “and to reach as many people as humanly possible.”