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Hanley GE, Niu J, Han J, Fung S, Bryant H, Kwon JS, Huntsman DG, Finlayson SJ, McAlpine JN, Miller D, Earle CC. Opportunistic salpingectomy between 2011 and 2016: a descriptive analysis. CMAJ Open 2022; 10:E466-E475. [PMID: 35640988 PMCID: PMC9177200 DOI: 10.9778/cmajo.20210219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Opportunistic salpingectomy (OS) is the removal of fallopian tubes during hysterectomy for benign indications or instead of tubal ligation, for the purpose of preventing ovarian cancer. We determined rates of OS at the time of hysterectomy and tubal sterilization and examined how they changed over the study period. METHODS Using data from the Canadian Institute for Health Information's Discharge Abstract Database and National Ambulatory Care Reporting System for all Canadian provinces and territories (except Quebec) between the fiscal years 2011 and 2016, we conducted a descriptive analysis of all patients aged 15 years or older who underwent hysterectomy or tubal sterilization. We excluded those with diagnostic codes for any gynecologic cancer and those who underwent unilateral salpingectomy. We examined the proportion who had OS during their hysterectomy and compared the proportion of tubal sterilizations that were OS with the proportion that were tubal ligations. RESULTS A total of 318 528 participants were included in the study (mean age 42.5 yr). The proportion of hysterectomies that included OS increased from 15.4% in 2011 to 35.5% by 2016. With respect to tubal sterilization, the rate of OS increased from 6.5% of all tubal sterilizations in 2011 to 22.0% in 2016. There was considerable variation across jurisdictions in 2016, with British Columbia having the highest rates (53.2% of all hysterectomies and 74.0% of tubal sterilizations involved OS). INTERPRETATION The rates of OS increased between 2011 and 2016, but there was considerable variation across the included jurisdictions. Our study indicates room for rates of OS to increase across many of the included jurisdictions.
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Affiliation(s)
- Gillian E Hanley
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta.
| | - Jin Niu
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
| | - Jihee Han
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
| | - Sharon Fung
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
| | - Heather Bryant
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
| | - Janice S Kwon
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
| | - David G Huntsman
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
| | - Sarah J Finlayson
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
| | - Jessica N McAlpine
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
| | - Dianne Miller
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
| | - Craig C Earle
- Division of Gynaecologic Oncology (Hanley, Kwon, Huntsman, Finlayson, McAlpine, Miller), Department of Gynaecology and Obstetrics, and Department of Pathology and Laboratory Medicine (Huntsman), University of British Columbia; Vancouver Coastal Health (Finlayson), Vancouver, BC; Canadian Partnership Against Cancer (Niu, Han, Fung, Bryant, Huntsman, Earle), Toronto, Ont.; Department of Community Health Sciences (Bryant) and Department of Oncology (Bryant), University of Calgary, Calgary, Alta
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van Lieshout LAM, Steenbeek MP, De Hullu JA, Vos MC, Houterman S, Wilkinson J, Piek JMJ. Hysterectomy with opportunistic salpingectomy versus hysterectomy alone. Cochrane Database Syst Rev 2019; 8:CD012858. [PMID: 31456223 PMCID: PMC6712369 DOI: 10.1002/14651858.cd012858.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ovarian cancer has the highest mortality rate of all gynaecological malignancies with an overall five-year survival rate of 30% to 40%. In the past two decades it has become apparent and more commonly accepted that a majority of ovarian cancers originate in the fallopian tube epithelium and not from the ovary itself. This paradigm shift introduced new possibilities for ovarian cancer prevention. Salpingectomy during a hysterectomy for benign gynaecological indications (also known as opportunistic salpingectomy) might reduce the overall incidence of ovarian cancer. Aside from efficacy, safety is of utmost importance, especially due to the preventive nature of opportunistic salpingectomy. Most important are safety in the form of surgical adverse events and postoperative hormonal status. Therefore, we compared the benefits and risks of hysterectomy with opportunistic salpingectomy to hysterectomy without opportunistic salpingectomy. OBJECTIVES To assess the effect and safety of hysterectomy with opportunistic salpingectomy versus hysterectomy without salpingectomy for ovarian cancer prevention in women undergoing hysterectomy for benign gynaecological indications; outcomes of interest include the incidence of epithelial ovarian cancer, surgery-related adverse events and postoperative ovarian reserve. SEARCH METHODS The Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two clinical trial registers were searched in January 2019 together with reference checking and contact with study authors. SELECTION CRITERIA We intended to include both randomised controlled trials (RCTs) and non-RCTs that compared ovarian cancer incidence after hysterectomy with opportunistic salpingectomy to hysterectomy without opportunistic salpingectomy in women undergoing hysterectomy for benign gynaecological indications. For assessment of surgical and hormonal safety, we included RCTs that compared hysterectomy with opportunistic salpingectomy to hysterectomy without opportunistic salpingectomy in women undergoing hysterectomy for benign gynaecological indications. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcomes were ovarian cancer incidence, intraoperative and short-term postoperative complication rate and postoperative hormonal status. Secondary outcomes were total surgical time, estimated blood loss, conversion rate to open surgery (applicable only to laparoscopic and vaginal approaches), duration of hospital admission, menopause-related symptoms and quality of life. MAIN RESULTS We included seven RCTs (350 women analysed). The evidence was of very low to low quality: the main limitations being a low number of included women and surgery-related adverse events, substantial loss to follow-up and a large variety in outcome measures and timing of measurements.No studies reported ovarian cancer incidence after hysterectomy with opportunistic salpingectomy compared to hysterectomy without opportunistic salpingectomy in women undergoing hysterectomy for benign gynaecological indications. For surgery-related adverse events, there were insufficient data to assess whether there was any difference in both intraoperative (odds ratio (OR) 0.66, 95% confidence interval (CI) 0.11 to 3.94; 5 studies, 286 participants; very low-quality evidence) and short-term postoperative (OR 0.13, 95% CI 0.01 to 2.14; 3 studies, 152 participants; very low-quality evidence) complication rates between hysterectomy with opportunistic salpingectomy and hysterectomy without opportunistic salpingectomy because the number of surgery-related adverse events was very low. For postoperative hormonal status, the results were compatible with no difference, or with a reduction in anti-Müllerian hormone (AMH) that would not be clinically relevant (mean difference (MD) -0.94, 95% CI -1.89 to 0.01; I2 = 0%; 5 studies, 283 participants; low-quality evidence). A reduction in AMH would be unfavourable, but due to wide CIs, the postoperative change in AMH can still vary from a substantial decrease to even a slight increase. AUTHORS' CONCLUSIONS There were no eligible studies reporting on one of our primary outcomes - the incidence of ovarian cancer specifically after hysterectomy with or without opportunistic salpingectomy. However, outside the scope of this review there is a growing body of evidence for the effectiveness of opportunistic salpingectomy itself during other interventions or as a sterilisation technique, strongly suggesting a protective effect. In our meta-analyses, we found insufficient data to assess whether there was any difference in surgical adverse events, with a very low number of events in women undergoing hysterectomy with and without opportunistic salpingectomy. For postoperative hormonal status we found no evidence of a difference between the groups. The maximum difference in time to menopause, calculated from the lower limit of the 95% CI and the natural average AMH decline, would be approximately 20 months, which we consider to be not clinically relevant. However, the results should be interpreted with caution and even more so in very young women for whom a difference in postoperative hormonal status is potentially more clinically relevant. Therefore, there is a need for research on the long-term effects of opportunistic salpingectomy during hysterectomy, particularly in younger women, as results are currently limited to six months postoperatively. This limit is especially important as AMH, the most frequently used marker for ovarian reserve, recovers over the course of several months following an initial sharp decline after surgery. In light of the available evidence, addition of opportunistic salpingectomy should be discussed with each woman undergoing a hysterectomy for benign indication, with provision of a clear overview of benefits and risks.
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Affiliation(s)
- Laura A M van Lieshout
- Catharina Cancer Institute, Catharina HospitalDepartment of Obstetrics and GynaecologyMichelangelolaan 2EindhovenNetherlands5623EJ
- Radboud University Nijmegen Medical CentreDepartment of Obstetrics and GynaecologyNijmegenNijmegenNetherlands6525 GA
| | - Miranda P Steenbeek
- Radboud University Nijmegen Medical CentreDepartment of Obstetrics and GynaecologyNijmegenNijmegenNetherlands6525 GA
| | - Joanne A De Hullu
- Radboud University Nijmegen Medical CentreDepartment of Obstetrics and GynaecologyNijmegenNijmegenNetherlands6525 GA
| | - M Caroline Vos
- Elisabeth‐TweeSteden HospitalObstetrics and GynaecologyHilvarenbeekseweg 60TilburgNetherlands5000LC
| | - Saskia Houterman
- Catharina HospitalDepartment of Education and ResearchMichelangelolaan 2EindhovenNetherlands5623 EJ
| | - Jack Wilkinson
- Manchester Academic Health Science Centre (MAHSC), University of ManchesterCentre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and HealthClinical Sciences Building Salford Royal NHS Foundation Trust HospitalRoom 1.315, Jean McFarlane Building University Place Oxford RoadManchesterUKM13 9PL
| | - Jurgen MJ Piek
- Catharina Cancer Institute, Catharina HospitalDepartment of Obstetrics and GynaecologyMichelangelolaan 2EindhovenNetherlands5623EJ
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Adopting a Uniform Approach to Site Assignment in Tubo-Ovarian High-Grade Serous Carcinoma: The Time has Come. Int J Gynecol Pathol 2017; 35:230-7. [PMID: 26977579 DOI: 10.1097/pgp.0000000000000270] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There is currently sufficient evidence that nonuterine high-grade serous carcinoma (HGSC) originates in the fallopian tube in the majority of cases, but this is not uniformly reflected in our diagnostic terminology. This is because there remains wide variation in awareness and acceptance of this evidence, which conflicts with traditional views on origin. Accurate disease classification is fundamental to routine clinical practice and research, particularly at a time when exciting new approaches to therapy, early detection, and prevention are appearing on the horizon. We feel the time has come to minimize individual and institutional variations in practice, and agree on an evidence-based approach to uniform terminology and primary site assignment. In this paper we put forward a proposal for a unified approach based on published research evidence and discuss the reasons why it is vital to agree on a uniform protocol. We propose the term "Tubo-ovarian HGSC" in preference to "pelvic" or "Müllerian," as it accurately reflects the origin of this disease in the vast majority of cases, and is unambiguous, distinguishing it clearly from uterine serous carcinoma and ovarian low-grade serous carcinomas. A detailed protocol for primary site assignment is presented for different scenarios, which is easy to follow and has been developed with a view to promoting a uniform approach worldwide.
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4
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Abstract
In the absence of significant benefit from either novel therapeutics or screening, the focus of decreasing ovarian cancer incidence and mortality has shifted toward primary prevention. Histopathologic data have demonstrated that up to 70% of ovarian cancers may actually arise from the fallopian tube. This has led to the increased adoption of opportunistic salpingectomy as a tool for ovarian cancer prevention. In turn, the potential surgical risks and ovarian cancer prevention of this emerging practice have generated multiple studies. In this comprehensive review, we address the origins of ovarian cancer, the historical context and recent trends of tubal surgery, the existing population-based data on ovarian cancer risk reduction, and provide a detailed review of the evidence on surgical risks of salpingectomy. To date, the safety and ovarian cancer risk reduction evidence sheds a positive light on opportunistic salpingectomy. Although research on this subject has grown substantially in recent years, there remains a paucity of large, prospective studies that examine clinical outcomes.
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5
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Abstract
Ovarian cancer remains to be the most lethal of all gynecologic malignancies. There is no effective screening test proven to reduce the mortality associated with this disease. Costs of treating ovarian cancer are substantial and among the highest of all cancer types. Therefore, it is essential to pursue strategies to prevent ovarian cancer that are cost-effective in the context of our health care system. There are 2 subgroups of women for whom ovarian cancer prevention strategies have been evaluated for effectiveness and costs: (1) general population at risk, and (2) BRCA mutation carriers with a high lifetime risk.
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6
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Dilley SE, Havrilesky LJ, Bakkum-Gamez J, Cohn DE, Michael Straughn J, Caughey AB, Rodriguez MI. Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention. Gynecol Oncol 2017; 146:373-379. [PMID: 28577884 DOI: 10.1016/j.ygyno.2017.05.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Data suggesting a link between the fallopian tube and ovarian cancer have led to an increase in rates of salpingectomy at the time of pelvic surgery, a practice known as opportunistic salpingectomy (OS). However, the potential benefits, risks and costs for this new practice are not well established. Our objective was to assess the cost-effectiveness of opportunistic salpingectomy at the time of laparoscopic permanent contraception or hysterectomy for benign indications. METHODS We created two models to compare the cost-effectiveness of salpingectomy versus usual care. The hypothetical study population is 50,000 women aged 45 undergoing laparoscopic hysterectomy with ovarian preservation for benign indications, and 300,000 women aged 35 undergoing laparoscopic permanent contraception. SEER data were used for probabilities of ovarian cancer cases and deaths. The ovarian cancer risk reduction, complication rates, utilities and associated costs were obtained from published literature. Sensitivity analyses and Monte Carlo simulation were performed, and incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per quality adjusted life year (QALY) gained. RESULTS In the laparoscopic hysterectomy cohort, OS is cost saving and would yield $23.9 million in health care dollars saved. In the laparoscopic permanent contraception cohort, OS is cost-effective with an ICER of $31,432/QALY compared to tubal ligation, and remains cost-effective as long as it reduces ovarian cancer risk by 54%. Monte Carlo simulation demonstrated cost-effectiveness with hysterectomy and permanent contraception in 62.3% and 55% of trials, respectively. CONCLUSIONS Opportunistic salpingectomy for low-risk women undergoing pelvic surgery may be a cost-effective strategy for decreasing ovarian cancer risk at time of hysterectomy or permanent contraception. In our model, salpingectomy was cost-effective with both procedures, but the advantage greater at time of hysterectomy.
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Affiliation(s)
- Sarah E Dilley
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Mail Code L-466, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, 20 Duke Medicine Cir, Durham, NC 27710, United States.
| | - Jamie Bakkum-Gamez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st Ave SW, Rochester, MN 55902, United States.
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University, 456 W 10th Ave, Columbus, OH 43210, United States.
| | - J Michael Straughn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Ave S., Rm 10250, Birmingham, AL 35233, United States.
| | - Aaron B Caughey
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Mail Code L-466, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
| | - Maria I Rodriguez
- Section of Family Planning, Department of Obstetrics and Gynecology, Oregon Health and Science University, Mail Code L-466, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
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Urban N, Hawley S, Janes H, Karlan BY, Berg CD, Drescher CW, Manson JE, Palomares MR, Daly MB, Wactawski-Wende J, O'Sullivan MJ, Thorpe J, Robinson RD, Lane D, Li CI, Anderson GL. Identifying post-menopausal women at elevated risk for epithelial ovarian cancer. Gynecol Oncol 2015; 139:253-60. [PMID: 26343159 PMCID: PMC4664187 DOI: 10.1016/j.ygyno.2015.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We developed and validated a hybrid risk classifier combining serum markers and epidemiologic risk factors to identify post-menopausal women at elevated risk for invasive fallopian tube, primary peritoneal, and ovarian epithelial carcinoma. METHODS To select epidemiologic risk factors for use in the classifier, Cox proportional hazards analyses were conducted using 74,786 Women's Health Initiative (WHI) Observational Study (OS) participants. To construct a combination classifier, 210 WHI OS cases and 536 matched controls with serum marker measurements were analyzed; validation employed 143 cases and 725 matched controls from the WHI Clinical Trial (CT) with similar data. RESULTS Analyses identified a combination risk classifier composed of two elevated-risk groups: 1) women with CA125 or HE4 exceeding a 98% specificity threshold; and 2) women with intact fallopian tubes, prior use of menopausal hormone therapy for at least two years, and either a first degree relative with breast or ovarian cancer or a personal history of breast cancer. In the WHI OS population, it classified 13% of women as elevated risk, identifying 30% of ovarian cancers diagnosed up to 7.8years post-enrollment (Hazard Ratio [HR]=2.6, p<0.001). In the WHI CT validation population, it classified 8% of women as elevated risk, identifying 31% of cancers diagnosed within 7years of enrollment (HR=4.6, p<0.001). CONCLUSION CA125 and HE4 contributed significantly to a risk prediction classifier combining serum markers with epidemiologic risk factors. The hybrid risk classifier may be useful to identify post-menopausal women who would benefit from timely surgical intervention to prevent epithelial ovarian cancer.
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Affiliation(s)
- Nicole Urban
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | - Sarah Hawley
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Holly Janes
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Beth Y Karlan
- Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | | | | | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Melanie R Palomares
- Cancer Prevention, Inc., Las Vegas NV and Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mary B Daly
- Fox Chase Cancer Center, Philadelphia PA, United States
| | | | | | - Jason Thorpe
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Randal D Robinson
- University of Texas Health Science Center, San Antonio TX, United States
| | - Dorothy Lane
- Stony Brook University, Stony Brook, NY, United States
| | - Christopher I Li
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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The secondary Müllerian system, field effect, BRCA, and tubal fimbria: our evolving understanding of the origin of tubo-ovarian high-grade serous carcinoma and why assignment of primary site matters. Pathology 2015; 47:423-31. [DOI: 10.1097/pat.0000000000000291] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Verkuyl DAA. FIGO's ethical recommendations on female sterilisation will do more harm than good: a commentary. JOURNAL OF MEDICAL ETHICS 2015; 41:478-87. [PMID: 25009073 PMCID: PMC4453628 DOI: 10.1136/medethics-2013-101827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 05/30/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
The International Federation of Gynecology and Obstetrics (FIGO) Committee for the Ethical Aspects of Human Reproduction and Women's Health advises against tubal occlusion (TO) performed at the time of caesarean section (CS/TO) or following a vaginal delivery (VD/TO) if this sterilisation has not been discussed with the woman in an earlier phase of her pregnancy. This advice is neither in accordance with existing medical custom nor evidence based. Particularly in less-resourced locations, adherence to it would deny much wanted one-off sterilisation opportunities to hundreds of thousands of women, many of whom have no reliable contraceptive alternative. To be sure, a well-timed discussion in pregnancy about a potential peripartum TO is preferable and, if conducted as a matter of course (as the Committee appears to promote), would represent an enormous improvement on current practice. Earlier counselling has the advantage that it results in fewer women who regret having rejected the CS/TO or VD/TO option. However, there is no evidence that earlier counselling leads to a smaller proportion of regretted sterilisations. Consequently, where early TO counselling has been impossible, forgotten or deliberately omitted on pronatalist, traditional, financial, cultural or religious grounds, offering a perinatal sterilisation belatedly and in an unbiased, culturally sensitive manner is often verifiably better than not presenting that option at all, notably where high parity and uterine scars are particularly dangerous. Belated counselling, as will be demonstrated in this paper, saves many lives. The Committee's blanket rejection of belated counselling on perinatal sterilisation is therefore unjustified.
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Affiliation(s)
- D A A Verkuyl
- Refaja Hospital, Obs & Gyn Department, Stadskanaal and
- CASA Klinieken, Leiden, The Netherlands
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10
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Adler E, Mhawech-Fauceglia P, Gayther SA, Lawrenson K. PAX8 expression in ovarian surface epithelial cells. Hum Pathol 2015; 46:948-56. [PMID: 26079312 DOI: 10.1016/j.humpath.2015.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/21/2015] [Accepted: 03/30/2015] [Indexed: 12/24/2022]
Abstract
High-grade serous ovarian carcinoma (HGSOC) is usually diagnosed at a late stage and is associated with poor prognosis. Understanding early stage disease biology is essential in developing clinical biomarkers to detect HGSOC earlier. While recent studies indicate that HGSOCs arise from fallopian tube secretory epithelial cells, a considerable body of evidence suggests that HGSOC can also arise from ovarian surface epithelial cells (OSECs). PAX8 is overexpressed in HGSOCs and expressed in fallopian tube secretory epithelial cells, but there are conflicting reports about PAX8 expression in OSECs. The purposes of this study were to comprehensively characterize PAX8 expression in a large series of OSECs and to investigate the role of PAX8 in early HGSOC development. PAX8 protein expression was analyzed in the OSECs of 27 normal ovaries and 7 primary OSEC cultures using immunohistochemistry and immunofluorescent cytochemistry. PAX8 messenger RNA expression was quantified in 66 primary OSEC cultures. Cellular transformation was evaluated in OSECs expressing a PAX8 construct. PAX8 was expressed by 44% to 71% of OSECs. Calretinin and E-cadherin were frequently coexpressed with PAX8. Expression of PAX8 in OSECs decreased cellular migration (P = .028), but had no other effects on cellular transformation. In addition, PAX8 expression was significantly increased (P = .003) in an in vitro stepwise model of neoplastic transformation. In conclusion, PAX8 is frequently expressed by OSECs, and endogenous levels of PAX8 expression are non-transforming. These data indicate that in OSECs, PAX8 expression may represent a normal state and that OSECs may represent an origin of HGSOCs.
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Affiliation(s)
- Emily Adler
- Department of Preventive Medicine, University of Southern California/Keck School of Medicine, Los Angeles, CA 90033.
| | - Paulette Mhawech-Fauceglia
- Departments of Medicine and Pathology, University of Southern California/Keck School of Medicine, Los Angeles, CA 90033.
| | - Simon A Gayther
- Department of Preventive Medicine, University of Southern California/Keck School of Medicine, Los Angeles, CA 90033.
| | - Kate Lawrenson
- Department of Preventive Medicine, University of Southern California/Keck School of Medicine, Los Angeles, CA 90033.
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Singh N, Gilks CB, Wilkinson N, McCluggage WG. Assessment of a new system for primary site assignment in high-grade serous carcinoma of the fallopian tube, ovary, and peritoneum. Histopathology 2015; 67:331-7. [DOI: 10.1111/his.12651] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 01/12/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Naveena Singh
- Department of Cellular Pathology; Barts Health NHS Trust; London UK
| | - C Blake Gilks
- Department of Pathology; Vancouver General Hospital and University of British Columbia; Vancouver BC Canada
| | | | - W Glenn McCluggage
- Department of Pathology; Belfast Health and Social Care Trust; Belfast UK
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Ovarian cancer survival by tumor dominance, a surrogate for site of origin. Cancer Causes Control 2015; 26:601-8. [PMID: 25771796 DOI: 10.1007/s10552-015-0547-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/27/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Recent studies suggest that a proportion of ovarian tumors may actually originate in the distal fallopian tube. The objective of this study was to examine the relationship between dominance (a surrogate for site of origin) and survival, following a diagnosis of epithelial ovarian cancer. METHODS We classified 1,386 tumors as dominant (putatively originating in the ovary) and non-dominant (putatively originating in the fallopian tube), using parameters obtained from pathology reports. Dominant tumors were restricted to one ovary or one involved ovary that exceeded the other in dimension by at least twofold, while non-dominant tumors were identified as having a greater likelihood of a tubal origin if the disease was equally distributed across the ovaries. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) associated with dominance. RESULTS Non-dominant tumors were more likely to be serous, stage III/IV, and be associated with a BRCA1/2 mutation, increasing parity and use of estrogen hormone replacement therapy (p ≤ 0.01). In contrast, 46 and 26% of the dominant tumors were serous and endometrioid, respectively, with a more even distribution of stage (p < 0.0001). Women with a non-dominant tumor had an increased risk of death compared to women with a dominant tumor (multivariate HR 1.28; 95% CI 1.02-1.60). Findings were similar in our analysis restricted to serous only subtypes (HR 1.28; 95% CI 1.01-1.63). CONCLUSION These preliminary findings suggest significantly worse survival among women diagnosed with a tumor putatively arising from fallopian tube.
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Incidental Nonuterine High-grade Serous Carcinomas Arise in the Fallopian Tube in Most Cases. Am J Surg Pathol 2015; 39:357-64. [DOI: 10.1097/pas.0000000000000353] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Early Detection of High-grade Tubal Serous Carcinoma in Women at Low Risk for Hereditary Breast and Ovarian Cancer Syndrome by Systematic Examination of Fallopian Tubes Incidentally Removed During Benign Surgery. Am J Surg Pathol 2014; 38:729-42. [DOI: 10.1097/pas.0000000000000199] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Verkuyl DAA. 'Mevrouw, there is more regret and failure following a sterilization together with a caesarean, and all those hormones in pregnancy preclude rational judgement'. Eur J Obstet Gynecol Reprod Biol 2014; 179:251. [PMID: 24857311 DOI: 10.1016/j.ejogrb.2014.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/14/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Affiliation(s)
- D A A Verkuyl
- Refaja Ziekenhuis, Stadskanaal and CASA Kliniek, Leiden, The Netherlands
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Karlan BY, Thorpe J, Watabayashi K, Drescher CW, Palomares M, Daly MB, Paley P, Hillard P, Andersen MR, Anderson G, Drapkin R, Urban N. Use of CA125 and HE4 serum markers to predict ovarian cancer in elevated-risk women. Cancer Epidemiol Biomarkers Prev 2014; 23:1383-93. [PMID: 24789859 DOI: 10.1158/1055-9965.epi-13-1361] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Serum markers are used before pelvic imaging to improve specificity and positive predictive value (PPV) of ovarian cancer multimodal screening strategies. METHODS We conducted a randomized controlled pilot trial to estimate surgical PPV of a "2 of 3 tests positive" screening rule, and to compare use of HE4 as a first-line (Arm 1) versus a second-line (Arm 2) screen, in women at high and elevated risk for epithelial ovarian cancer (EOC) at five study sites. Semiannual screening was offered to 208 women ages 25 to 80 years with deleterious BRCA germline mutations and to 834 women ages 35 to 80 years with pedigrees suggesting inherited susceptibility. Annual screening was offered to 130 women ages 45 to 80 years (Risk Group 3) with epidemiologic and serum marker risk factors. Rising marker levels were identified using the parametric empirical Bayes algorithm. RESULTS Both strategies yielded surgical PPV above 25%. Protocol-indicated surgery was performed in 6 women, identifying two ovarian malignancies and yielding a surgical PPV in both arms combined of 33% (95% confidence interval: 4%-78%), 25% in Arm 1 and 50% in Arm 2. Surgical consultation was recommended for 37 women (26 in Arm 1 and 11 in Arm 2). On the basis of 12 women with at least 2 of 3 tests positive (CA125, HE4, or imaging), an intent-to-treat analysis yielded PPV of 14% in Arm 1 and 20% in Arm 2. CONCLUSIONS Positive screens were more frequent when HE4 was included in the primary screen. IMPACT HE4 may be useful as a confirmatory screen when rising CA125 is used alone as a primary screen.
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Affiliation(s)
- Beth Y Karlan
- Authors' Affiliations: Cedars-Sinai Medical Center, Los Angeles;
| | | | | | - Charles W Drescher
- Fred Hutchinson Cancer Research Center; Pacific Gynecology Specialists, Seattle, Washington
| | | | - Mary B Daly
- Fox Chase Cancer Center, Philadelphia, Pennsylvania; and
| | - Pam Paley
- Pacific Gynecology Specialists, Seattle, Washington
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Schenberg T, Mitchell G. Prophylactic bilateral salpingectomy as a prevention strategy in women at high-risk of ovarian cancer: a mini-review. Front Oncol 2014; 4:21. [PMID: 24575389 PMCID: PMC3918654 DOI: 10.3389/fonc.2014.00021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/26/2014] [Indexed: 12/23/2022] Open
Abstract
Risk-reducing bilateral salpingo-oophorectomy is a proven strategy to reduce the risk of serous ovarian cancer associated with germline BRCA mutations. It is most effective when performed before natural menopause, but it will render a woman prematurely menopausal. The tubal hypothesis of serous ovarian cancer brings with it the possibility of the alternative surgical approach in younger women comprising of risk-reducing bilateral salpingectomy while conserving their ovaries until nearer the age of natural menopause, when a delayed bilateral oophorectomy can be performed. This article will review the evidence behind the tubal hypothesis of serous ovarian cancer and explore the opportunities for translating this into clinical cancer prevention practice.
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Affiliation(s)
- Tess Schenberg
- The Western Health Public Hospital, Melbourne, VIC, Australia
| | - Gillian Mitchell
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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