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Opportunistic and interventional salpingectomy in women at risk: a strategy for preventing pelvic serous cancer (PSC)

  • M.W. Kamran
    Correspondence
    Corresponding author at: Department of Gynecological Oncology, St James's Hospital, James's Street, Dublin 8, Ireland. Tel.: +353 1 4103000.
    Affiliations
    Division of Gynecological Oncology/Department of Obstetrics & Gynecology, St James's Hospital and Trinity College, Dublin 8, Ireland
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  • D. Vaughan
    Affiliations
    Division of Gynecological Oncology/Department of Obstetrics & Gynecology, St James's Hospital and Trinity College, Dublin 8, Ireland
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  • D. Crosby
    Affiliations
    Division of Gynecological Oncology/Department of Obstetrics & Gynecology, St James's Hospital and Trinity College, Dublin 8, Ireland
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  • N.A. Wahab
    Affiliations
    Division of Gynecological Oncology/Department of Obstetrics & Gynecology, St James's Hospital and Trinity College, Dublin 8, Ireland
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  • F.A. Saadeh
    Affiliations
    Division of Gynecological Oncology/Department of Obstetrics & Gynecology, St James's Hospital and Trinity College, Dublin 8, Ireland
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  • N. Gleeson
    Affiliations
    Division of Gynecological Oncology/Department of Obstetrics & Gynecology, St James's Hospital and Trinity College, Dublin 8, Ireland
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      Abstract

      Objective

      Salpingectomy is proposed as a prophylactic measure to reduce the incidence of tubo-ovarian/pelvic serous cancers. We surveyed the attitudes of obstetrician/gynecologists to incorporating salpingectomy opportunistically into surgery for benign conditions, and electively for young BRCA mutation carriers.

      Study design

      A questionnaire, designed to assess current standard clinical practice and willingness to perform salpingectomy for female sterilization at abdominal hysterectomy for benign disease (ABH), vaginal benign hysterectomy (VBH) and electively for women with BRCA mutations who wish to postpone oophorectomy was mailed to obstetrician/gynecologists working in Irish hospitals.

      Results

      In their current practice of interval female sterilization 96% of gynecologists applied clips at laparoscopy and 4% performed salpingectomy, and 73% were willing to consider salpingectomy. Eighty-one percent were willing to consider salpingectomy for sterilization at cesarean section. Gynecologists performing hysterectomy (without oophorectomy) for benign conditions did salpingectomy in 26% at ABH and 5.4% at VBH, and now 90% would consider salpingectomy at ABH and 66% at VBH. Two-thirds of respondents would consider salpingectomy for women at genetic risk of ovarian cancer who want to postpone oophorectomy.

      Conclusion

      Changing general gynecological practice to include more opportunistic salpingectomy has the potential to reduce the incidence of serous cancers. The majority of gynecologists are willing to incorporate more salpingectomies into their surgical practices and consider elective salpingectomy as an interim measure for women with defined genetic risk of pelvic serous cancer.

      Keywords

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