Karia, P. S., Joshu, C. E., & Visvanathan, K. (2021). Uptake and Predictors of Opportunistic Salpingectomy for Ovarian Cancer Risk Reduction in the United States. Cancer prevention research (Philadelphia, Pa.). https://doi.org/10.1158/1940-6207.CAPR-21-0121
Karia PS, Joshu CE, Visvanathan K. Uptake and Predictors of Opportunistic Salpingectomy for Ovarian Cancer Risk Reduction in the United States. Cancer prevention research (Philadelphia, Pa.). 2021. doi:10.1158/1940-6207.CAPR-21-0121
Karia, Pritesh S., et al. "Uptake and Predictors of Opportunistic Salpingectomy for Ovarian Cancer Risk Reduction in the United States." Cancer prevention research (Philadelphia, Pa.), 2021.
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RRM Academy Synopsis
Opportunistic salpingectomy rose rapidly in privately insured US women
Claims for 48,231,235 privately insured US women, 2010 to 2017, show that the rate of opportunistic salpingectomy rose 17.8-fold for sterilization and 7.6-fold during hysterectomy. The surgery removes the fallopian tubes and is proposed to reduce ovarian cancer risk. Its share of sterilization encounters grew from 1 out of 100 in 2010 to 20 out of 100 in 2017.
Key Findings
The age-adjusted incidence rate of opportunistic salpingectomy for sterilization increased 17.8-fold (95% CI: 16.2-19.5), and the rate during hysterectomy increased 7.6-fold (95% CI: 5.5-10.4), from 2010 to 2017.
The proportion of sterilization encounters involving opportunistic salpingectomy increased from 1% in 2010 to 20% in 2017. For benign hysterectomy encounters it increased from 1% to 32%.
Immediately after the November 2013 guideline release, the age-adjusted quarterly rate rose 250% (IRR: 3.51; 95% CI: 2.53-4.86) for sterilization and 109% (IRR: 2.09; 95% CI: 1.65-2.63) for hysterectomy.
Compared with urban residence, rural residence was associated with lower use for sterilization (RR: 0.87; 95% CI: 0.83-0.91) and for hysterectomy (RR: 0.82; 95% CI: 0.79-0.85).
Genetic susceptibility to breast/ovarian cancer was associated with more use for sterilization (RR: 2.84; 95% CI: 2.31-3.49) and less use during hysterectomy (RR: 0.70; 95% CI: 0.55-0.90).
Interpretation
The study analyzed commercial insurance claims, an observational design. An interrupted time-series analysis compared rates before and after the November 2013 guideline release. The jump coincided with the guideline, and the design shows timing only. Participants were privately insured women under 65. The data lack race, ethnicity, education and body mass index. The authors report that only three observational studies have assessed ovarian cancer risk after the surgery, and none evaluated it specifically for risk reduction. They call for prospective studies of cancer outcomes and adverse effects.
RRM Context
Restorative reproductive medicine weighs the long-term effects of a surgery. The authors note that data on potential harms from this operation are limited, as are data on how well it works.
Our editorial summary of this paper, not the article's abstract.
Abstract
Evidence suggesting that high-grade serous ovarian cancers originate in the fallopian tubes has led to the emergence of opportunistic salpingectomy (OS) as an approach to reduce ovarian-cancer risk. In the U.S., some national societies now recommend OS in place of tubal ligation for sterilization or during a benign hysterectomy in average-risk women. However, limited data exist on the dissemination of OS in clinical practice. We examined the uptake and predictors of OS in a nationwide sample of inpatient and outpatient claims (N = 48,231,235) from 2010 to 2017. Incidence rates of OS were calculated, and an interrupted time-series analysis was used to quantify changes in rates before (2010-2013) and after (2015-2017) national guideline release. Predictors of OS use were examined using Poisson regression. From 2010 to 2017, the age-adjusted incidence rate of OS for sterilization and OS during hysterectomy increased 17.8-fold [95% confidence interval (CI), 16.2-19.5] and 7.6-fold (95% CI, 5.5-10.4), respectively. The rapid increase (age-adjusted increase in quarterly rates of between 109% and 250%) coincided with the time of national guideline release. In multivariable-adjusted analyses, OS use was more common in young women and varied significantly by geographic region, rurality, family history/genetic susceptibility, surgical indication, inpatient/outpatient setting, and underlying comorbidities. Similar differences in OS uptake were noted in analyses limited to women with a family history/genetic susceptibility to breast/ovarian cancer. Our results highlight significant differences in OS uptake in both high- and average-risk women. Defining subsets of women who would benefit most from OS and identifying barriers to equitable OS uptake is needed.
Prevention Relevance
Opportunistic salpingectomy for ovarian-cancer risk reduction has been rapidly adopted in the U.S., with significant variation in uptake by demographic and clinical factors. Studies examining barriers to opportunistic salpingectomy access and the long-term effectiveness and potential adverse effects of opportunistic salpingectomy are needed.
