title: Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention.
abstract: OBJECTIVE
  The purpose of this study was to assess the uptake and perioperative safety of bilateral salpingectomy (BS) as an ovarian cancer risk-reduction strategy in low-risk women after a regional initiative that was aimed at general gynecologists in the province of British Columbia, Canada.
  
  
  METHODS
  This population-based retrospective cohort study evaluated 43,931 women in British Columbia from 2008-2011 who underwent hysterectomy that was performed with and without BS or bilateral salpingo-oophorectomy or who underwent surgical sterilization by means of BS or tubal ligation. Parameters that were examined include patient age, operating time, surgical approach, indication, length of hospital stay, and perioperative complications.
  
  
  RESULTS
  There was an increase in the uptake of hysterectomy with BS (5-35%; P < .001) and BS for sterilization (0.5-33%; P < .001) over the study period, particularly in women <50 years old. Minimal additional surgical time is required for hysterectomy with BS (16 minutes; P < .001) and BS for sterilization (10 minutes; P < .001) compared with hysterectomy alone or tubal ligation, respectively. No significant differences were observed in the risks of hospital readmission or blood transfusions in women who underwent hysterectomy with BS (adjusted odds ratio [aOR], 0.91; 95% confidence interval [CI], 0.75-1.10; and aOR, 0.86; 95% CI, 0.67-1.10, respectively) or BS for sterilization (aOR, 0.8; 95% CI, 0.56-1.21; and aOR, 0.75; 95% CI, 0.32-1.73, respectively). From 2008-2011 the proportion of hysterectomies with BS performed by open laparotomy decreased from 77-44% with uptake in laparoscopic, vaginal, and combined procedures (P < .001).
  
  
  CONCLUSIONS
  After our 2010 educational initiative, there has been a shift in surgical paradigm in our province. This cancer prevention approach does not increase the risk of operative/perioperative complications and appears both feasible and safe.
authors.affiliation: Department of Gynecology and Obstetrics Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency. Electronic address: jessica.mcalpine@vch.ca.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: McAlpine
authors.affiliation: School of Population and Public Health, Child and Family Research Institute, University of British Columbia.
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Hanley
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency; Center for Translational and Applied Genomics, BC Cancer Agency.
authors.forename: Michelle M M
authors.initials: MM
authors.lastname: Woo
authors.affiliation: Division of Gynecologic Oncology, Princess Margaret Cancer Center.
authors.forename: Alicia A
authors.initials: AA
authors.lastname: Tone
authors.affiliation: Center for Translational and Applied Genomics, BC Cancer Agency.
authors.forename: Nirit
authors.initials: N
authors.lastname: Rozenberg
authors.affiliation: Department of Medicine, University of British Columbia and BC Cancer Agency.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Swenerton
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency.
authors.forename: C Blake
authors.initials: CB
authors.lastname: Gilks
authors.affiliation: Department of Gynecology and Obstetrics Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Finlayson
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency; Center for Translational and Applied Genomics, BC Cancer Agency.
authors.forename: David G
authors.initials: DG
authors.lastname: Huntsman
authors.affiliation: Department of Gynecology and Obstetrics Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency.
authors.forename: Dianne M
authors.initials: DM
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D001955:British Columbia; D004502:Education, Medical, Continuing; D005187:Fallopian Tubes / Q000503:physiopathology; D005260:Female; D006176:Gynecology / Q000193:education; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D016017:Odds Ratio; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D058994:Salpingectomy / Q000706:statistics & numerical data; D013246:Sterilization, Tubal; D055815:Young Adult
keywords: educational campaign; ovarian cancer; prevention; safety; salpingectomy