Adoption of opportunistic salpingectomy for ovarian cancer prevention: Results from a nationwide sample of privately insured women.

Abstract

1561 Background: Recent evidence indicates that the Fallopian tube is the site of origin for many high-grade serous ovarian cancers, particularly in BRCA carriers. This has led to the emergence of opportunistic salpingectomy (OS) as a novel ovarian cancer prevention strategy. Despite limited data, some national societies now recommend OS for ovarian cancer prevention during benign hysterectomy or in place of tubal ligation for sterilization in average-risk women. We assessed patient characteristics associated with increased likelihood of OS and national trends in OS adoption before and after release of recommendations. Methods: Data from MarketScan were used to identify women who underwent hysterectomy, tubal ligation, and OS from 2010-2017. Rates of OS were compared and interrupted time series analysis with segmented Poisson regression was used to examine immediate and persistent changes in OS rates before and after recommendations. Rates were calculated quarterly and models were adjusted for age and seasonality. Results: A total of 309,574 tubal ligations, 13,574 OS for sterilization, 293,000 hysterectomies, 22,798 hysterectomies with OS were included. Quarterly rates of OS for sterilization and hysterectomy with OS were 3.13 and 4.82 per 100,000 women, respectively. About 92% of OS for sterilization and 56% of hysterectomy with OS were performed in women < 45 years. The most common indication for hysterectomy with OS was uterine fibroids (46%). About 8% of OS for sterilization and 10% of hysterectomy with OS were performed in women with a family history of breast or ovarian cancer. After adjusting for age and seasonality, there was a 250% immediate increase (RR: 3.50; 95% CI: 2.59-4.72) followed by a 14% (RR: 1.14; 95% CI: 1.10-1.18) persistent increase in the quarterly rate of OS for sterilization after versus before recommendation release. There was a 109% immediate increase (RR: 2.09; 95% CI: 1.15-3.81) in the quarterly rate of hysterectomy with OS after versus before recommendation release. No persistent change in the rate of hysterectomy with OS was observed. Significant declines in hysterectomy and tubal ligation rates were observed and these declines were temporally associated with the release of recommendations. Conclusions: OS for ovarian cancer prevention has rapidly diffused into clinical practice with the speed of adoption bolstered by recommendations from national societies. Future studies evaluating the overall efficacy and long-term complications of OS are needed to support its continued widespread use.