Highlight
This article explores the impact of physician peer influence on the uptake of opportunistic salpingectomy during tubal sterilization. It highlights that surgeons connected with peers who frequently perform salpingectomy are significantly more likely to adopt this preventive surgical approach, which reduces ovarian cancer risk. The findings are drawn from a large retrospective cohort study utilizing insurance claims data.
Study Background and Disease Burden
Ovarian cancer remains a significant cause of gynecological cancer mortality worldwide due to often late diagnosis and limited effective screening options. Emerging evidence implicates the fallopian tubes as the site of origin for many high-grade serous ovarian cancers, shifting preventive strategies toward prophylactic salpingectomy. Opportunistic salpingectomy—removal of fallopian tubes during sterilization with ovarian preservation—has therefore gained attention as a measure to reduce ovarian cancer risk without compromising hormonal function. Despite increasing advocacy, uptake of opportunistic salpingectomy has been variable, with multiple factors influencing adoption including provider knowledge, surgical training, and institutional policies. Understanding the social and professional dynamics that drive the diffusion of this practice, particularly the role of physician peer influence, is critical to optimizing preventive care delivery.
Study Design
This retrospective cohort study analyzed data from the Blue Cross Blue Shield Axis insurance claims database. The study population included women aged 18 to 49 years undergoing tubal sterilization either immediately postpartum or during interval (non-pregnancy-related) procedures between January 2020 and December 2022. Importantly, the operating surgeons had no previous baseline use of opportunistic salpingectomy during 2017-2019. Physician peer networks were constructed using a Louvain clustering methodology based on shared patients coded in insurance claims data during the baseline period. The key exposure was the rate of opportunistic salpingectomy performed by peer physicians within the same network at baseline.
The main outcome was whether the patient’s surgeon adopted opportunistic salpingectomy, defined as bilateral removal or removal of the remaining fallopian tube with ovarian preservation, at the time of sterilization.
Key Findings
The cohort comprised 4,520 postpartum sterilization patients and 3,376 interval sterilization patients. Most postpartum procedures (92.3%) occurred during cesarean deliveries, and about 77% of women in both cohorts were aged 30 to 49 years.
In the postpartum cohort, surgeons with peers in the highest quartile of opportunistic salpingectomy usage at baseline had patients with significantly higher adjusted odds of receiving the procedure (13.6%) compared to surgeons with peers in the lowest quartile (5.6%)—adjusted odds ratio (aOR) 2.17 (95% CI, 1.20-3.92, P < .001).
Similarly, in the interval sterilization cohort, the rate of opportunistic salpingectomy was substantially higher (42.3%) among surgeons whose peer networks had the highest baseline adoption compared to those with lowest peer adoption (19.3%), with an aOR of 4.16 (95% CI, 1.98-8.77, P < .001).
These findings demonstrate a strong positive association between peer physician practices and individual surgeon adoption of opportunistic salpingectomy, underscoring the role of social network influences on clinical decision-making.
Expert Commentary
This study provides compelling evidence that physician peer networks are important influencers in shifting surgical practice towards ovarian cancer prevention. The Louvain clustering method offers an innovative approach to delineate physician connections beyond formal institutional affiliations, capturing real-world patient-sharing patterns.
The increased adoption seen in interval sterilizations compared to postpartum may reflect greater opportunity to counsel and plan preventive surgery independently of delivery timing, though cesarean-based postpartum sterilizations provide a practical setting for opportunistic salpingectomy.
Limitations include reliance on claims data, which may imperfectly capture clinical nuances or physician intent, and potential confounding by other unmeasured factors such as institutional protocols or surgeon experience. Nevertheless, the results complement growing clinical guidelines advocating opportunistic salpingectomy and highlight that peer influence mechanisms can be leveraged to accelerate evidence-based practice adoption.
Conclusion
This large retrospective cohort study reveals that physicians embedded within networks characterized by high rates of opportunistic salpingectomy use are significantly more likely to integrate this cancer preventive approach in their own tubal sterilization procedures. The findings underscore the potential of peer influence as a key driver to enhance adoption of ovarian cancer risk-reducing surgeries. Targeted interventions fostering peer engagement and sharing of best practices could further improve opportunistic salpingectomy uptake, thereby contributing to ovarian cancer prevention efforts. Future research should explore strategies to harness social networks and address barriers to widespread implementation in diverse clinical settings.
References
Xu X, Long JB, Pollack CE, Desai VB, Gross CP, Spatz ES, Wright JD. Physician Peer Influence on Salpingectomy Uptake for Tubal Sterilization and Ovarian Cancer Prevention. JAMA Netw Open. 2025 Sep 2;8(9):e2532998. doi: 10.1001/jamanetworkopen.2025.32998. PMID: 40982280.
Additional references for context on opportunistic salpingectomy and ovarian cancer prevention:
1. Falconer H, Yin L, Grönberg H, Dickman PW, Johansson ALV. Ovarian cancer risk after salpingectomy: A nationwide population-based study. J Natl Cancer Inst. 2015;107(2):dju410.
2. American College of Obstetricians and Gynecologists. Role of the fallopian tube in the pathogenesis of ovarian cancer: ACOG committee opinion No. 774. Obstet Gynecol. 2019;133(5):e330-e336.
3. Nezhat C, Apostol R, Wise M, et al. Opportunistic salpingectomy for ovarian cancer prevention: Practice patterns and recommendations. Obstet Gynecol Surv. 2020;75(9):535-539.
