Peer networks drive use of opportunistic salpingectomy for ovarian cancer prevention

Peer networks drive use of opportunistic salpingectomy for ovarian cancer prevention | Image Credit: © N Felix/peopleimages.com - © N Felix/peopleimages.com- stock.adobe.com.

The odds of adopting opportunistic salpingectomy into practice are increased among surgeons previously sharing patients with physicians who have high rates of opportunistic salpingectomy use, according to a recent study published in JAMA Network Open.¹

Despite having one of the highest death rates of any gynecological cancer, ovarian cancer does not have routine screening, indicating benefits from primary prevention. Opportunistic salpingectomy (OS), defined as removal of both fallopian tubes, has been highlighted as a way to provide sterilization and reduce ovarian cancer risk.²

“Given varying knowledge gaps among physicians about OS, there is likely substantial subjectivity in their beliefs prone to peer influence,” wrote investigators.¹

Patient-sharing network assessment

The retrospective cohort study was conducted to determine the presence of peer influence in OS adoption for permanent sterilization in clinical practice. Data was obtained from the Blue Cross Blue Shield Axis database, with clinicians considered peers if they practiced in the same network. This allowed researchers to develop physician patient-sharing networks.

Participants included physicians not performing OS for tubal sterilization from 2017 to 2019, defined as time 1 (T1). Sociodemographic characteristics and medical care data from patients aged 18 to 49 undergoing tubal sterilization between 2020 and 2022 was collected to assess the impact of peer physicians’ OS practice in T1 on participant practices during this timeframe.

Procedural codes for tubal ligation and salpingectomy indicated tubal sterilization, with the T2 sterilization sample limited to baseline nonusers to assess OS adoption. Patients with hysterectomy, ovarian or fallopian tube disorders, and cancer or increased cancer risk were excluded from the analysis.

Primary outcomes and OS rates

The T1 patient-sharing sample was used to formulate physician-patient sharing networks. Physicians billing for 4 or more patients and sharing at least 2 patients with another physician were considered connected. Patients seeing a significant number of physicians were capped to the top 8 in terms of interaction-days.

Receiving OS in the T2 sterilization sample was reported as the primary outcome. In the T1 sample, OS rates were measured as the proportion of sterilization procedures using OS during the T1 period. Physicians in the T1 and T2 samples were linked to measure T1 peer physician OS rates for each T2 surgeon.

There were 4520 patients included in the T2 postpartum sterilization sample, receiving surgery by 1312 surgeons who did not use OS at baseline. In comparison, 3376 patients were included in the T2 interval sterilization sample, undergoing the procedure by 1158 surgeons who did not use OS at baseline.

Impact of peer influence on OS adoption

T2 operating surgeons were part of patient-sharing networks where a median 12 physicians conducted sterilization at baseline. OS was provided to 7.8% of patients in the postpartum sterilization sample and 26.7% in the interval sterilization sample between 2020 and 2022. Physician networks were linked to 22.4% and 31.6% of the variation in OS use in these samples, respectively.

Increased rates of receiving OS were reported among T2 patients whose operating surgeon has peer physicians in the highest quartile of baseline OS vs the lowest quartile, at 5.6% and 13.6%, respectively, in the postpartum sterilization sample. In comparison, rates were 19.3% and 42.3%, respectively, in the interval sterilization sample.

Overall, a 2.17-fold increase in receiving OS during T2 was reported among patients of physicians in the highest baseline OS quartile. Additionally, no significant interaction was reported for peer exposure and network density.

Implications

These results indicated increased OS adoption for sterilization among physicians with peers utilizing the procedure. Investigators concluded this correlation may be used to spread OS use for ovarian cancer prevention.

“Variation in OS uptake for sterilization by nonclinical factors underscores a need to address inequity in accessing this preventive strategy,” wrote investigators.

References

1. Xu X, Long JB, Pollack CE, et al. Physician peer influence on salpingectomy uptake for tubal sterilization and ovarian cancer prevention. JAMA Netw Open. 2025;8(9):e2532998. doi:10.1001/jamanetworkopen.2025.32998
2. Committee opinion no. 620: Salpingectomy for ovarian cancer prevention. Obstet Gynecol. 2015;125(1):279-281. doi:10.1097/01.AOG.0000459871.88564.09