A population-based assessment of an ovarian cancer prevention program
Specific Objectives: We propose to build a population-based cohort using the linkable administrative datasets in BC to address the following research questions:
1. Are patients undergoing hysterectomy with salpingectomy or salpingectomy for sterilization at increased risk for serious adverse events (death, hospital readmission, blood transfusion, increased length of stay in hospital), and minor adverse events (post-surgical infection, increased number of physician visits, and need for pharmacologic pain relief) compared to patients undergoing hysterectomy alone or tubal ligation?
2. What are the procedure-specific health system costs of opportunistic salpingectomy? Is opportunistic salpingectomy a cost-effective ovarian cancer prevention strategy?
3. Was the 2010 educational campaign effective in increasing the rates of BRCA1/2 mutation referrals and testing among HGSC patients and their female relatives? Did this result in increased risk-reducing interventions and increased prevention strategies among BRCA1/2 carriers? Are BRCA1/2 carriers using all preventive strategies available to them including chemopreventive and surgical strategies? Are there differences in the use of preventive strategies by jurisdiction or patient sociodemographics?
4. Are BRCA 1/2 carriers at increased risk for cancers other than breast and ovarian cancers?
5. How protective are routine gynecologic surgeries (including hysterectomy, hysterectomy with bilateral salpingectomy and oophorectomy, tubal ligation, and opportunistic salpingectomy) against ovarian cancer? Does this differ according to ovarian cancer histologic subtype?
6. What are the lifetime risks of ovarian cancer among average risk women (i.e., excluding BRCA1/2 mutation carriers)?
1. We hypothesize that there will be no differences in rates of any adverse events between women undergoing hysterectomy with salpingectomy and hysterectomy alone and among women undergoing salpingectomy for sterlization and women undergoing tubal ligation.
2. We hypothesize that the procedure specific costs will be slightly higher for opportunistic salpingectomy, but that opportunistic salpingectomy will be a cost-effective procedure assuming that it is effective in decreasing risk of ovarian cancer.
3. We hypothesize that the rate of BRCA1 and BRCA1 testing increased following the 2010 OVCARE recommendation and that the rate of risk reducing interventions among BRCA1/2 carriers also increased. We hypothesize that BRCA 1/2 carriers are using preventive strategies but that there will be some preventive strategies that are underused in certain jurisdictions or among certain patient subgroups.
4. We hypothesize that BRCA 1/2 carriers may be at increased risk for other cancers beyond breast and ovarian cancer.
5. We hypothesize that other gynecologic surgeries, including hysterectomy alone and tubal ligation will be protective against high grade serous ovarian cancers, endometrioid ovarian cancer, and clear cell ovarian cancer.
6. We hypothesize that we can model lifetime risk for ovarian cancer in the BC population and that using such a moel we will be able to distinguish individual risk according to a woman's exposure to known protective factors (years of oral contraceptive use, parity, etc).