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Recently, I had a lengthy conversation with an obstetrician/gynecologist sister-friend of mine about women’s health issues. We spoke about women dying during childbirth and how the United States ranked the worst among industrialized countries. Delving deeper, we agreed there was a significant disparity in health and healthcare services for women of different ethnic groups. It was not lost on us that black women were 2 -3 times more likely to die during childbirth than white women.

We continued our discussion, and as if she was reading my mind, she mentioned that maternal health was not the only area where we see disparity in women’s health. 

“Did you know Black and Hispanic women were less likely to get an opportunistic salpingectomy?” She asked.

“I thought every woman was getting opportunistic salpingectomy when indicated. I was not aware there was a disparity,” I responded.

Our conversation ended quickly because I was on call and had to respond to a patient. But I decided to investigate the subject further. In doing so, I came across the article titled, Racial and ethnic differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States. The article stated that when women have a hysterectomy, 60.3% of white women get the opportunistic salpingectomy. In comparison, only 18.8% of Blacks, 12.2% of Hispanics, and 8.7% of non-Hispanic other races got the procedure. For tubal sterilization surgeries, 64.7 % of Whites got the opportunistic salpingectomy, while only 10.8 % of Blacks, 16.7% of Hispanics, and 7.8% of non-Hispanic other races got the same.  My friend was correct. How is this still happening with this wide a disparity when, in 2015, the studies were clear that although your risk of ovarian cancer is not eliminated, the risk of ovarian cancer can be decreased by an opportunistic salpingectomy?

What is an opportunistic salpingectomy? It is the removal of the fallopian tubes for a woman who is already undergoing some other kind of pelvic surgery. We now know that we can decrease, not eliminate, the risk of ovarian cancer by taking out the fallopian tubes. The fallopian tube is what carries the sperm to meet the egg, and once the egg is fertilized, the fertilized egg is brought back through the tube to implant in the uterus to form the baby. If you are having a pelvic procedure where you will no longer be able to get pregnant, there is no reason to keep your fallopian tubes. If you have a hysterectomy (removal of your uterus), have your doctor remove the fallopian tubes. This has nothing to do with your ovaries.  The fallopian tubes can be removed without removing the ovaries. If you decide to have a sterilization surgery so that you no longer have children, have your fallopian tubes removed during the procedure. This should occur at the same time you are having a sterilization procedure – during a cesarean section, after a vaginal delivery, or at any other time you choose this as a form of birth control.

Why are Black, Hispanic, and non-Hispanic other races not getting an opportunistic salpingectomy? The article could not give a reason. The National Guidelines have been out since 2015. I have my theories.

What do we do now? If you have had a hysterectomy or sterilization and still have some of your tubes, you do not have to do anything. We need to move forward. You are now armed with information. You can share the information. Tell your family members and friends, especially those who will be having pelvic surgery and have decided not to have any more children.

Prior to the surgery, ask your physician the following:

Will you be taking out my fallopian tubes? I heard by taking out my fallopian tubes, I can decrease my risk of getting ovarian cancer.

For those who have decided to have permanent sterilization as a form of birth control, you need to know the following:

Make sure you tell your physician I want my fallopian tubes removed. I heard by taking out my fallopian tubes, I can decrease my risk of getting ovarian cancer.

Stop saying I am “getting my tubes tied.” That is an old phrase. It would be best if you were saying I am getting my fallopian tubes removed.

As I wrote in my first blog on July 26, 2015:

…The information available on this website is not meant as a substitute for your physician. The information provided here should help facilitate your interaction with your doctor or doctors, make you a better advocate for yourself and those important to you, and get a good value for your healthcare dollars. I want you to be aware of what is available.

Our knowledge of women’s health keeps changing, and in my role as a doctor, I want you to be informed.  We can change the statistics. We can close the gap in disparity when it comes to opportunistic salpingectomy, but you must demand it unless your physician has a valid reason for not adding the procedure to the primary one. Doctors have an ethical obligation to treat every patient the same way, regardless of race. All women, regardless of ethnic group, having pelvic surgery or tubal sterilization should be informed and offered opportunistic salpingectomy.