Physician Peer Influence Drives Uptake of Opportunistic Salpingectomy for Ovarian Cancer Prevention

Surgeons who previously shared patients with physicians who frequently performed opportunistic salpingectomy (OS) were more likely to adopt the procedure themselves, according to a study published in JAMA Network Open, suggesting that physician peer influence contributes to OS uptake for ovarian cancer risk reduction.¹

Evidence suggests that high-grade serous ovarian cancer, the most common and aggressive ovarian cancer type, originates from the fallopian tubes. Because of this, the researchers explained that the removal of both fallopian tubes after childbearing can provide the dual benefits of sterilization and reduced ovarian cancer risk.

In 2015, the American College of Obstetrics and Gynecologists recommended that physicians counsel patients about using OS as a sterilization option, after which use of the procedure rapidly increased. Specifically, OS performed at the time of cesarean delivery rose from 4.6% in 2015 to 13.2% in 2018 nationwide.²

However, uptake of OS has varied widely among clinicians, influenced by differences in beliefs about its benefits, complication risks, and impact on surgical time.¹ Given the varying knowledge gaps among physicians about OS, the researchers suggested that physician attitudes toward OS may be particularly susceptible to peer influence.

To explore this, they conducted a retrospective cohort study examining how physician peer networks affected OS uptake during postpartum and interval (non–pregnancy-related) sterilizations. OS was defined as the removal of both or the remaining fallopian tubes while preserving the ovaries. To do so, they used insurance claims from the Blue Cross Blue Shield (BCBS) Axis database, which includes comprehensive information on each enrollee’s sociodemographic characteristics and medical care.

Eligible participants were patients aged 18 to 49 years who underwent postpartum or interval sterilizations between 2020 and 2022, whose operating surgeons did not perform OS during baseline (2017-2019).

Using a Louvain clustering methodology, the researchers constructed physician patient-sharing networks based on claims data from the baseline period. Focusing on surgeons who did not perform OS for tubal sterilization between 2017 and 2019, the researchers examined whether there was an association between their peers’ OS practice during this time frame and their subsequent use of the procedure between 2020 and 2022.

The study included 4520 postpartum sterilizations performed by 1312 surgeons who had not used OS at baseline, with 92.3% (n = 4173) involving a cesarean delivery. It also included 3376 interval sterilizations performed by 1158 surgeons who did not use OS at baseline. Most patients in the postpartum (77.9%; n = 3520) and interval (77.0%; n = 2599) sterilization samples were between the ages of 30 and 49.

Between 2020 and 2022, 7.8% (n = 353) of patients in the postpartum sterilization sample and 26.7% (n = 902) of those in the interval sterilization sample received OS. Physician networks explained 22.4% (95% CI, 11.9%-32.3%) and 31.6% (95% CI, 21.8%-40.3%) of the variation in OS use among postpartum and interval sterilizations, respectively.

The researchers grouped surgeons into quartiles based on their peers’ mean baseline OS rates (0%-2.4%; >2.4%-7.8%; >7.8%-16.9%; and >16.9%). Compared with those treated by surgeons with peers in the lowest quartile, patients whose surgeons had peers in the highest quartile were significantly more likely to receive OS (61 of 1097 [5.6%] vs 164 of 1202 [13.6%] in the postpartum sterilization sample; 156 of 808 [19.3%] vs 353 of 835 [42.3%] in the interval sterilization sample; both P < .001).

Multivariable regression analysis showed that OS use was also associated with more recent years of surgery, higher body mass index, location in the Northeast, and cesarean delivery. Conversely, lower OS use was seen among patients in the South, those living in areas with high social vulnerability, and those treated by surgeons with higher procedural volumes.

The researchers acknowledged several limitations, including the use of data from a single insurer, which restricted generalizability and their ability to assess the role of health insurance in influencing OS uptake. They also lacked patient race and ethnicity data, limiting the evaluation of potential disparities. Nonetheless, the researchers noted that their findings underscore the influence of physician networks on OS use.

“This may be an underrecognized mechanism that can be leveraged in future dissemination of OS for ovarian cancer prevention,” the authors concluded. “Variation in OS uptake for sterilization by nonclinical factors underscores a need to address inequity in accessing this preventive strategy.”

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. Mandelbaum RS, Matsuzaki S, Sangara RN, et al. Paradigm shift from tubal ligation to opportunistic salpingectomy at cesarean delivery in the United States. Am J Obstet Gynecol. 2021;225(4):399.e1-399.e32. doi:10.1016/j.ajog.2021.06.074