Salpingectomy for Ovarian Cancer Risk Reduction: Improving Utilization and Informed Decision-Making

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Often referred to as the “silent killer”, ovarian cancer lacks specific symptoms and effective screening. Patients are often diagnosed at advanced stage with poor prognosis. Thus, primary prevention is particularly beneficial. Conventionally, prophylactic removal of the ovaries at the time of hysterectomy was used to prevent ovarian cancer, but that causes surgical menopause and impairs patients’ cardiovascular, bone, and cognitive health. New evidence on ovarian carcinogenesis, however, shows that most ovarian cancers originate from the fallopian tubes rather than from the ovaries. This reveals a better opportunity for ovarian cancer prevention – prophylactic salpingectomy (removing the fallopian tubes while preserving the ovaries), which can effectively reduce ovarian cancer risk without the detrimental effects of hormonal deprivation. It also expands the patient population that can benefit from ovarian cancer prevention to women undergoing sterilization, a setting where cancer prevention was not considered previously. Yet, salpingectomy uptake varies widely among providers with largely unknown reasons, and patients are often unaware of ovarian cancer risk reduction associated with salpingectomy. The overarching objective of this project is to improve quality of care for prophylactic salpingectomy by identifying provider- and patient-related barriers to utilization and promoting informed decision-making. Our specific aims are: 1) to identify distinct practice phenotypes in adopting prophylactic salpingectomy among physicians and compare physician attributes across these phenotypes; 2) to examine the role of social contagion among physicians in influencing salpingectomy uptake; 3) to ascertain physician perceived barriers to salpingectomy uptake and shared decision-making; and 4) to evaluate quality of decision- making regarding prophylactic salpingectomy from patients’ perspective and identify influencing factors. We will focus on women who are at low to average risk for ovarian cancer where prophylactic salpingectomy (with ovarian conservation) confers the most benefit. We will draw on unique data available in large healthcare databases, including the Premier Healthcare Database, State Inpatient Database/State Ambulatory Surgery and Services Database, and Blue Cross Blue Shield Axis database, supplemented by primary data collection directly from physicians and patients through focus groups, interviews, and surveys. This project is innovative because it studies an adjunctive procedure (among women who are already undergoing surgery) as a unique opportunity for cancer prevention with little added patient burden, employs a novel latent class growth analysis to identify distinct phenotypes of physicians in their trajectory (level and slope) of adopting prophylactic salpingectomy, and applies the nascent social network analytics to study connections among physicians and how it affects salpingectomy uptake via peer influence (a previously untapped mechanism for interventions). With over 1.2 million women undergoing hysterectomy and sterilization in the U.S. each year, findings from this study will enhance our ability to capitalize on this prime opportunity for ovarian cancer prevention.