Gauging the Magnitude of Missed Opportunity for Ovarian Cancer Prevention

Importance The impact of salpingectomy on the prevention of high-grade serous cancer (HGSC) at the population level is currently under investigation. Objective To determine the frequency of missed opportunity for salpingectomy with/without oophorectomy among patients diagnosed with HGSC. Design, Setting, and Participants This mixed-methods, multi-institutional retrospective study included patients diagnosed with HGSC at 2 academic medical centers between 2015 and 2021. Clinicopathologic data were abstracted from medical records. An electronic survey was also administered to members of a national ovarian cancer organization who self-identified as having had an HGSC diagnosis. The retrospective cohort included 1877 patients with HGSC and the survey included 917 respondents, of which 348 were diagnosed with HGSC. These data were analyzed from May 2023 and August 2023. Exposure Missed opportunity was defined as a history of either a surgical procedure resulting in permanent contraception (bilateral tubal ligation or hysterectomy without concurrent salpingectomy) at any age or another abdomino-pelvic surgery at 45 years or older when salpingectomy could have been performed 1 year or more preceding a diagnosis of HGSC. Main Outcome and Measure The proportion of HGSCs that could have been prevented with salpingectomy. Results Of the 445 patients (23.7%) with missed opportunities for salpingectomy in the retrospective cohort, 241 had a tubal ligation/hysterectomy (54.2%) and 204 had other abdomino-pelvic surgeries (45.8%). Cholecystectomy, hernia repair, and bowel surgeries were more commonly performed for patients 45 years or older than for younger patients. Among the 348 survey respondents, missed opportunity was reported by 54 (15.5%). The study team uncovered a 43.2% missed opportunity rate for germline genetic testing and reflex risk-reducing surgery among patients with an affected first-degree relative in the retrospective cohort. Conclusions and Relevance A considerable proportion of patients with HGSC missed opportunities for risk assessment with genetic testing and for surgical prevention. Given the lack of effective screening and limited treatment options for HGSC, eradicating it requires addressing the full spectrum of missed opportunities.