Opportunistic salpingectomy may reduce ovarian cancer risk

Abstract

resulted in a 42% to 64% reduction in ovarian cancer incidence; however , few studies have comprehensively assessed the dissemination of OS in clinical settings. Prior studies assessing OS uptake were limited to inpatient settings, which are not where most benign gynecologic surgeries occur. In the current study, researchers evaluated 48,231,235 inpatients and outpatients from hospitals and ambulatory surgical centers across the United States who had no history of breast or gynecologic cancer on the basis of their insurance claims from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database. Without revealing identities of the patients, the database includes some demographic information as well as admitting and discharge diagnoses and procedure codes. The researchers found that between the years 2010 and 2017, there were 1,046,525 with claims filed for tubal ligation, OS, or hysterectomy. Among these, the researchers excluded 303,348 women who also had insurance claims for an oophorectomy or a salpingo-oophorectomy during hysterectomy as well as 97,021 hysterectomy patients whose claims did not reveal whether additional ad-nexal structures were removed and 7200 subjects who had an ectopic pregnancy, pelvic inflammatory disease , or pelvic infections. There were 863 patients aged 50 years or older who underwent sterilization; they were excluded because women in that age group rarely undergo tubal ligation and OS for sterilization. The analytic sample of 638,093 women who had benign gynecologic surgeries, identified by International Classification of Diseases procedure codes (9th and 10th revisions) and Current Procedural Terminology codes, was divided into 4 groups: • Tubal ligation: 308,833 patients. • OS for sterilization: 13,462 patients. • Hysterectomy alone without OS: 293,000 patients. • Hysterectomy and OS: 22,798 patients. Study Results Between the years 2010 and 2017, the age-adjusted incidence rates of OS for sterilization and during hysterectomy increased 17.8-fold (95% CI, 16.2-19.5) and 7.6-fold (95% CI, 5.5-10.4), respectively. They noted that the rapid age-adjusted increases in quarterly rates of 109% and 250%, respectively, matched when national guidelines by the Society of Gynecologic Oncology were released in 2013. Dr. Visvanathan says that one of the study's most important findings was that the dissemination of the procedure was not uniform with respect to patient demographic and clinical characteristics and especially with respect to where patients lived. For example, they identified greater OS use for younger women, with 94% of OS procedures performed in women aged 50 years or younger, and a higher uptake of OS for sterilization in women with a genetic predisposition for and/or a family history of breast and ovarian cancers. Dr. Visvanathan says that for women with a genetic predisposition, this could reflect salpingectomy before oophorectomy, which is currently being evaluated in a clinical trial among BRCA1 mutation carriers. Another finding was that OS use during hysterectomy was higher among women undergoing an abdominal hysterectomy and among women with uterine fibroids. They also reported on a notable variation in OS uptake for high-risk women based on where they lived: "We found there were higher uptakes of OS in the Northeast and West and lower OS uptakes in the Midwest and South and in rural areas compared to urban locations ." They attributed these differences to variation in provider and patient knowledge and preferences regarding OS use and insurance coverage.