Exploring opportunistic salpingectomy as a preventive strategy for ovarian cancer: uptake in Newfoundland and Labrador, Canada

Abstract

Ovarian cancer (OC), the fifth deadliest cancer for women, had an estimated 3,100 cases in Canada in 2023, with a 66% mortality rate and approximately 1,950 projected deaths. High-grade serous carcinoma (HGSC), comprising 75% of OC cases, presents challenges in screening and early detection. Advances in understanding the origins of HGSC led to the identification of serous tubal intraepithelial carcinomas (STICs) in the fallopian tubes, introducing opportunistic salpingectomy (OS) as a preventative measure. The feasibility, safety, cost-effectiveness, and efficacy of OS have been investigated in multiple studies. A narrative review was conducted to address all these elements by assessing the effect of OS on surgical and post-surgical complications and on ovarian reserve. Overall, the addition of OS to hysterectomy or instead of tubal ligation appears to be safe and feasible. Available retrospective studies demonstrated that OS reduces the risk of OC in the general population by 35% to 65%. Due to the novelty of this approach, our understanding of the uptake of OS is limited in different clinical settings. The second manuscript presented in this thesis is a quantitative retrospective study that assessed the uptake of OS in Newfoundland and Labrador (NL) between 2010 and 2019. All patients who underwent any or any combination of hysterectomy, salpingectomy, oophorectomy, or tubal ligation were included in the analysis. The number of cases with gynecological cancers following the surgery was also reported for each group. Over the study period, the uptake of OS at the time of hysterectomy and as an alternative to tubal ligation increased by 10.3-fold and 28.1- fold, respectively. However, despite this upward trend, there is still room to enhance its adoption in NL, Canada.