OPS vs RRS: April 2026 AJOG

This episode of Dr. Chapa’s OBGYN Clinical Pearls dissects the critical distinction between opportunistic salpingectomy (OPS) and risk-reducing salpingectomy (RRS), clarifying that despite common confusion, they are fundamentally different procedures with distinct indications and evidence bases. The host emphasizes that OPS—removal of the fallopian tubes during other gynecological surgeries like cesarean delivery or hysterectomy—is a well-supported, ACOG- and NCCN-endorsed strategy for reducing ovarian cancer risk in the general population, with strong data from the 2015 Swedish study showing up to 65% risk reduction. In contrast, RRS—removing only the tubes in high-risk patients with BRCA or Lynch syndrome mutations—is not endorsed by any major medical society due to lack of proven efficacy and incomplete cancer risk reduction. The April 2026 clinical opinion in the American Journal of Obstetrics & Gynecology reinforces this, stating that RRS should only be considered within clinical trials and not as standard care. The episode stresses that in high-risk patients, the only proven strategy remains risk-reducing salpingo-oophorectomy (RRSO) at age-appropriate intervals based on genetic mutation. The host urges clinicians to stop using the term RRS and to educate patients accordingly, especially to avoid false reassurance and missed opportunities for optimal cancer prevention. Key takeaways include: (1) OPS is standard of care for all patients with completed fertility during any index surgery; (2) RRS is not a valid standalone strategy for BRCA or Lynch patients; (3) Always use the CFIM protocol when performing OPS to ensure proper pathological evaluation; (4) For high-risk patients, RRSO remains the gold standard, not RRS; (5) Patient counseling must be precise to avoid misleading them about cancer risk reduction. The episode concludes with a strong call to action for clinicians to align practice with current evidence and consensus guidelines.