Risk-Reducing Salpingectomy: Considerations from an OBGYN Perspective

Abstract

Background With recent evidence that opportunistic salpingectomy is effective in preventing high grade serous carcinoma, it is imperative to consider the optimal use of this procedure. In this research, we investigated the opinions of obstetrician-gynecologists (OBGYNS) about the acceptability of using salpingectomy as a stand-alone surgery for people at higher-than-average lifetime risk (but without a pathogenic variant that increases risk for ovarian cancer) known as risk-reducing salpingectomy(RRS). Methods We conducted semi-structured interviews with purposefully sampled practicing OBGYNs in the province of British Columbia, Canada. We used qualitative interpretive description with inductive thematic analysis for data analysis. Our work was informed by the theoretical framework of acceptability. Results The nineteen participants included physicians from both general obstetrics and gynecology practices, as well as subspecialties. OBGYNs generally found RRS to be acceptable, though this acceptability was conditional on clinical, patient, and system-level factors. Five major themes suggest that: 1) There are risks and benefits of RRS, that if balanced might support acceptability; 2) It is important to define and identify the correct patient for RRS; 3) OBGYNs value patient autonomy in the decision to undergo RRS; 4) Reproductive justice and equity are intertwined and influenced by the history of forced and coerced sterilization; and 5) Formal guidance and the right environment are enablers of RRS. Conclusions This work provides initial evidence that, from the OBGYN perspective, RRS is acceptable in the right patient population, with considerations from those practicing on the front lines of ovarian cancer prevention.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Canadian Institutes of Health Research, Canada Graduate Scholarships Doctoral program. North Family Foundation, Vancouver General Hospital & University of British Columbia Hospital Foundation Gynecologic Cancer Initiative Clinical Trials Group Accelerating Grants Program. The funders of this research had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee/IRB of the University of British Columbia gave ethical approval for this work

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Data Availability

The data generated in this study are not publicly available due the risk of re-identification, but are available upon reasonable request from the corresponding author for study finding verification purposes.

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