Tischer, Kristin M.

Introduction/Objective Opportunistic salpingectomy (OS) has been shown to reduce high-grade serous ovarian cancer (HGSOC) by 42-80%, yet awareness of this strategy outside of obstetrics and gynecology remains limited. The objective of this study was to assess awareness and counseling practices regarding OS for HGSOC prevention among primary care providers (PCPs). Methods We conducted a cross-sectional survey study using a 6-item electronic survey evaluating PCP knowledge and counseling practices related to HGSOC prevention through OS. The study was conducted at a single tertiary care center with gynecologic oncology services. Survey items assessed awareness of HGSOC origin, awareness of OS as a preventative strategy, counseling frequency in the setting of abdominal or pelvic surgery, counseling comfort, and resources needed to increase confidence in recommending OS. Response formats included Likert scales and Yes/No/Unsure options. The survey was distributed by email to attending physicians and advanced practice providers (APPs) in the Department of Family Medicine (FM) and Internal Medicine (IM). Results Of 398 providers surveyed, 136 responded (34% overall response rate; FM 44%, IM 28%), including 96 attending physicians and 40 APPs. Most PCPs were unaware that HGSOC originates in the fallopian tubes (60%) and were unaware of OS as a preventive strategy (71%). Counseling was uncommon: 11% had ever counseled on OS, while 74% had not and 15% reported it was outside their scope. Most respondents (63%) reported being not at all comfortable counseling patients about OS. Providers identified clinical guidelines (60%), CME or training modules (50%), eligibility criteria (48%), gynecology collaboration pathways (48%), and patient-friendly materials (44%) as key supports to improve counseling confidence. Conclusion PCP awareness and counseling regarding OS are limited. Given that guideline support for OS has solidified only in recent years, these gaps are not surprising—and they represent a clear, actionable opportunity. PCPs are well-positioned to lead the expansion of ovarian cancer prevention beyond specialty care with the right tools and support.

Abstract Background Opportunistic bilateral salpingectomy (OBS), the removal of fallopian tubes during hysterectomy or instead of tubal ligation, is recommended to reduce ovarian cancer risk. However, data on the effectiveness of prophylactic OBS is limited. Methods This population-based retrospective cohort included individuals aged 18–80 in Ontario, Canada, who underwent OBS or comparator surgeries (hysterectomy with ovarian and tubal conservation or tubal ligation) from 2011 to 2023. Individuals with gynecologic cancer before or within six months of surgery were excluded. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards regression. Sensitivity analyses varied the time between surgery and cancer diagnosis to account for pre-existing serous tubal intraepithelial carcinomas. Results Among 196,839 individuals, 57,941 underwent OBS and 138,898 underwent comparator surgeries. 142 epithelial ovarian cancers were diagnosed (19 in the OBS group and 123 in the comparator surgery group). OBS was associated with reduced risk of any ovarian carcinoma, with an adjusted hazard ratio (aHR) of 0.60 (95% CI, 0.36 to 0.98). For serous ovarian carcinoma (high- and low-grade combined due to missing grade data), the aHR was 0.47 (95% CI, 0.22 to 0.99). Sensitivity analyses with 12- and 18-month intervals showed aHRs of 0.59 (95% CI, 0.35 to 0.99) and 0.60 (95% CI, 0.35 to 1.01) for all ovarian carcinomas, and 0.49 (95% CI, 0.23 to 1.01) and 0.47 (95% CI, 0.22 to 0.99) for serous ovarian carcinoma, respectively. Conclusions OBS was associated with reduced risk of ovarian carcinoma, supporting its role as a primary prevention strategy.

This cohort study evaluates the reduction in risk of high-grade serous carcinoma among women undergoing opportunistic bilateral salpingectomy in Canada.