Ovarian cancer is the deadliest form of cancer among women. Over the last 50 years, there has been little progress in reducing mortalities via medical interventions. In addition, the screening tests designed to detect this type of cancer in earlier, treatable stages have yielded little success. In some cases, the tests have returned false-positives, resulting in unnecessary surgeries and subsequent complications.
In January 2015, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion on prophylactic salpingectomy, the surgical removal of the fallopian tubes, as a preventive measure to protect at-risk patients from developing ovarian cancer. Prophylactic salpingectomy was a recent topic of a Hayes report, and we found that our clients were extremely interested in the evidence behind the procedure.
Hayes found that no health plans had developed coverage policy criteria for salpingectomy as a stand-alone procedure. Two plans referred to it as a procedure performed in conjunction with removal of the ovaries and covered the dual procedure when the patient met preliminary criteria. According to the ACOG, bilateral salpingo-oophorectomy can be offered to reduce risk in women possessing the BRCA1 or BRCA2 mutation after the age of 40 or once the child-bearing phase of their life has ended. Other findings suggest that bilateral salpingo-oophorectomy is a procedure reserved for women at the highest risk of epithelial ovarian and fallopian tubal cancer.
Although bilateral salpingo-oophorectomy is the most effective tool in reducing risk in this specific patient population, the removal of the ovaries has been tied to a number of subsequent health issues, including cardiovascular and cognitive dysfunctions. By separating the procedures and only performing salpingectomy, these negative side effects potentially might be avoided but the level of risk reduction may be compromised as well.
The last 10 years have yielded very few publications examining salpingectomy as a stand-alone surgery for ovarian cancer prevention (4 studies, 1 cost-effectiveness analysis, 2 physician surveys, and 3 review articles). Hayes determined that there was insufficient evidence available on the subject to properly assess the procedure. Conversely, Hayes did find sufficient evidence on prophylactic oophorectomy and was able to arrive at a rating. A summary of this report is available (click here).