First step in implementation of opportunistic salpingectomy for prevention of ovarian cancer: Current care and its determinants

Evaluation of a patient decision aid for opportunistic salpingectomy and salpingectomy as sterilization method to prevent ovarian cancer

INTRODUCTION

A patient decision aid on opportunistic salpingectomy and salpingectomy as a sterilization method has been developed to provide uniform counseling and reduce practice variation. The aim of this study was to evaluate the use of the patient decision aid in daily clinical practice to ensure its effectiveness and usability, as well as its influence on the decision-making process and the decision of opportunistic salpingectomy.

MATERIAL AND METHODS

As part of the STOPOVCA-implementation study, we conducted a multicenter observational study in 16 hospitals between July 2020 and February 2024. Patients who were eligible for opportunistic salpingectomy were invited to use the decision aid while they considered whether or not to undergo opportunistic salpingectomy. Digital questionnaires were used to evaluate the decision aid, the decision process, and patients' decisions 6-8 weeks post-surgery.

RESULTS

425 out of 542 patients participated in the questionnaire. A majority of these 425 patients received (N = 357; 84%) and used the decision aid (N = 347; 82%). Two thirds (N = 234; 67%) of those who used the decision aid stated that it increased their knowledge of opportunistic salpingectomy. Patients considered the decision aid a usable aid, allocating a score of 8.1 out of 10 and would recommend it to other patients facing the decision regarding opportunistic salpingectomy. Patients considered the extent to which they were involved in the decision-making process as high, and the decisional conflict low. The majority of patients who used the decision aid opted for opportunistic salpingectomy (N = 326; 95%). Main reasons for choosing opportunistic salpingectomy were the risk-reducing effect of ovarian cancer (N = 311; 90%) and the lack of functionality of the fallopian tubes after childbearing (N = 320; 92%).

CONCLUSIONS

The patient decision aid was used by a majority of patients who received it. The decision aid was regarded by patients as user-friendly, and it was recommended to be used in the decision-making process for opportunistic salpingectomy. Patients stated that the decision aid provides reliable information and increases patients' knowledge of opportunistic salpingectomy.

Evaluating Ovarian Cancer Risk-Reducing Salpingectomy Acceptance: A Survey

SIGNIFICANCE

This study found that many participants were willing to consider RRS to prevent ovarian cancer. Further research on RRS should be undertaken to understand how this can be best used for ovarian cancer prevention.

Ovarian cancer risk reduction by salpingectomy during non-gynaecological surgery: scoping review

BACKGROUND

Ovarian cancer is the leading cause of death among gynaecological cancers. The identification of the fallopian tube epithelium as the origin of most ovarian cancers introduces a novel prevention strategy by removing the fallopian tubes during an already indicated abdominal surgery for another reason, also known as an opportunistic salpingectomy. This preventive opportunity is evidence based, recommended and established at the time of gynaecologic surgery in many countries worldwide. To expand interest among surgeons in performing a salpingectomy during non-gynaecological surgery, the aim of this review is to identify knowledge gaps during those surgeries.

METHODS

A scoping review was performed following the PRISMA-Scoping Review (ScR) checklist. PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) database and Cochrane Library were systematically searched from inception to November 2024. Trial registers were searched for ongoing trials. All studies reporting original data on salpingectomy during non-gynaecological surgery were included. Outcomes were provided narratively.

RESULTS

Eighteen studies were identified reporting on the implementation, surgical feasibility, patients' perspectives, physicians' knowledge and cost-effectiveness of an opportunistic salpingectomy during non-gynaecological surgery. Population-level data indicate that an opportunistic salpingectomy is rarely performed in non-gynaecological surgeries. High success rates and no complications of an opportunistic salpingectomy were observed during bariatric surgery and cholecystectomies. However, performing an additional salpingectomy appeared more time-consuming. Patients had strong interest in information on and willingness to undergo opportunistic salpingectomy. Cost-effectiveness analysis encourages opportunistic salpingectomy use, as models show reduced ovarian cancer incidence and mortality rate while being cost-effective.

CONCLUSIONS

Opportunistic salpingectomy during non-gynaecologic surgery appears to be a promising method to prevent ovarian cancer. Implementing such a strategy will require education of multiple surgical disciplines, training and resolution of organizational issues.

Opportunistic Salpingectomy Between 2017 and 2020: A Descriptive Analysis

OBJECTIVES

Opportunistic salpingectomy (OS) is the removal of fallopian tubes during another pelvic surgery for the purpose of ovarian cancer prevention. Herein, we describe the rates of OS at the time of hysterectomy and tubal sterilization between 2017 and 2020.

METHODS

This study uses the Canadian Institute of Health Information's Discharge Abstract Database and National Ambulatory Care Reporting System for all Canadian provinces and territories except for Quebec between the fiscal years 2017 and 2020. A descriptive analysis on all people aged 15 years and older who had hysterectomies or tubal sterilizations was conducted to determine the proportion of hysterectomies that included bilateral salpingectomy (OS) and the proportion of tubal sterilizations that were OS compared to tubal ligation.

RESULTS

There were 174 006 people included in the study. The proportion of hysterectomies that included OS increased from 31.7% in 2017 to 39.9% by 2020. With respect to tubal sterilizations, rates of OS increased from 26.3% of all tubal sterilizations in 2017 to 42.5% in 2020. British Columbia remained the jurisdiction with the highest rates of OS, but rates increased significantly in many jurisdictions, particularly at the time of tubal sterilization.

CONCLUSION

The rates of OS have continued to increase in all Canadian jurisdictions following the official Society of Obstetricians and Gynaecologists of Canada recommendation to consider OS in 2015. Assuming that all tubal ligations could have been OS and 75% of hysterectomies with ovarian conservation could have included OS, our data indicate 76 932 missed opportunities for ovarian cancer prevention.

Ovarian Cancer: From Precursor Lesion Identification to Population-Based Prevention Programs

Epithelial ovarian cancer (EOC) is a heterogeneous group of malignancies, including high-grade serous ovarian cancer (HGSC). HGSC is often diagnosed at advanced stages and is linked to TP53 variants. While BRCA variants elevate risk, most HGSC cases occur in individuals without known genetic variants, necessitating prevention strategies for people without known high-risk genetic variants. Effective prevention programs are also needed due to the lack of traditional screening options. An emerging primary prevention strategy is opportunistic salpingectomy, which involves removing fallopian tubes during another planned pelvic surgery. Opportunistic salpingectomy offers a safe and cost-effective preventative option that is gaining global adoption. With the publication of the first cohort study of patients who underwent salpingectomy, specifically for cancer prevention, attention has turned to broadening opportunities for salpingectomy in addition to more targeted approaches. Prevention opportunities are promising with increasing adoption of salpingectomy and the increased understanding of the etiology of the distinct histotypes of ovarian cancer. Yet, further research on targeted risk-reducing salpingectomy with thoughtful consideration of equity is necessary to reduce death and suffering from ovarian cancer.