Abstract
Opportunistic salpingectomy (OS), which is the removal of fallopian tubes during hysterectomy or instead of tubal ligation without removal of ovaries, is recommended to prevent ovarian cancer, particularly serous ovarian cancer. However, the effectiveness of OS is still undetermined. To examine observed vs expected rates of ovarian cancer among individuals who have undergone OS. This is a population-based, retrospective cohort study of all individuals in British Columbia, Canada, who underwent OS or a control surgery (hysterectomy alone or tubal ligation) between 2008 and 2017, with follow-up until December 31, 2017. Those with any gynecological cancer diagnosed before or within 6 months of their procedure were excluded. Data analysis was performed from April to August 2021. Removal of both fallopian tubes at the time of hysterectomy or instead of tubal ligation while leaving ovaries intact. An ovarian cancer diagnosis listed in the British Columbia Cancer Registry. Age-specific rates of epithelial and serous ovarian cancer in the control group were combined with the specific follow-up time in the OS group to calculate expected numbers (and 95% CIs) of ovarian cancers in the OS group. These were compared with observed numbers. Age-adjusted expected and observed numbers of breast and colorectal cancers were also examined in the OS group. There were 25 889 individuals who underwent OS (mean [SD] age, 40.2 [7.1] years; median [IQR] follow-up, 3.2 [1.6-5.1] years) and 32 080 who underwent hysterectomy alone or tubal ligation (mean [SD] age, 38.2 [7.9] years; median [IQR] follow-up, 7.3 [4.6-8.7] years). There were no serous ovarian cancers in the OS group and 5 or fewer epithelial ovarian cancers. The age-adjusted expected number was 5.27 (95% CI, 1.78-19.29) serous cancers and 8.68 (95% CI, 3.36-26.58) epithelial ovarian cancers. Age-adjusted expected vs observed numbers of breast cancers (22.1 expected vs 23 observed) and colorectal cancers (9.35 expected vs 8 observed) were not significantly different. In this cohort study, the OS group had significantly fewer serous and epithelial ovarian cancers than were expected according to the rate at which they arose in the control group. These findings suggest that OS is associated with reduced ovarian cancer risk.
Highlights
70% of sporadic and most ovarian cancers in BRCA variant carriers are high-grade serous carcinomas (HGSCs),[1] which is the most lethal of the 5 main histotypes and has a 5-year survival rate less than 50%.2 the general population lifetime risk of ovarian cancer is 1.4%,3 individuals with an inherited germline BRCA1 or BRCA2 variant have average cumulative risks of 40% to 75% and 8% to 34%, respectively.[4]
Age-adjusted expected vs observed numbers of breast cancers (22.1 expected vs 23 observed) and colorectal cancers (9.35 expected vs 8 observed) were not significantly different. In this cohort study, the opportunistic salpingectomy (OS) group had significantly fewer serous and epithelial ovarian cancers than were expected according to the rate at which they arose in the control group
After exclusion of 74 individuals who were younger than age 15 years at the time of surgery and 2110 individuals with cancers that were diagnosed before or within 6 months of surgery, there were 25 889 individuals in the OS group, including 14 066 who underwent hysterectomy with OS and 11 823 who underwent OS for sterilization
Summary
70% of sporadic and most ovarian cancers in BRCA variant carriers are high-grade serous carcinomas (HGSCs),[1] which is the most lethal of the 5 main histotypes and has a 5-year survival rate less than 50%.2 the general population lifetime risk of ovarian cancer is 1.4%,3 individuals with an inherited germline BRCA1 or BRCA2 variant have average cumulative risks of 40% to 75% and 8% to 34%, respectively.[4]. Removal of the ovaries is not recommended for the general population because it is associated with increased total mortality, coronary heart disease, and osteoporosis.[6] a different preventive strategy is needed for individuals at average risk, who account for 80% of cases of HGSCs. The recent understanding that HGSC often originates in the fallopian tube[7,8] has led to a primary prevention opportunity for the general population—namely, opportunistic salpingectomy (OS). The same recommendation has since been made in many countries, including Canada, the US, and the UK for individuals without identified genetic factors associated with increased risk of ovarian cancer.[9,10,11,12] Research has shown that OS is safe, both in terms of perioperative adverse events[13] and minor complications,[14] there are no indications of an earlier age of onset of menopause following OS,[15] and it is cost-effective.[16]
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