Among gynecologic cancers, ovarian cancer has one of the highest mortality rates; there is no routine screening for this disease, so the crux of lowering the mortality related to ovarian cancer is primary prevention. Significant evidence shows that the most common and severe types of ovarian cancer originate in the fallopian tubes rather than the ovaries, meaning that the removal of the fallopian tubes (opportunistic salpingectomy, or OS) rather than their interruption (tubal ligation) may be beneficial in terms of cancer risk reduction in patients undergoing sterilization procedures. Recent guidelines have implemented this, recommending that physicians counsel patients about OS for sterilization though uptake is widely variable among clinicians. This study was designed to assess peer influence on clinicians’ implementation of OS. This was a retrospective cohort study that used data from commercial claims through the Blue Cross Blue Shield (BCBS) Axis database. Physician patient-sharing networks were used to define peer influence, with practitioners sharing patients being considered peers. Inclusion criteria for sterilization surgeries were women between the ages of 18 and 49 who had a tubal sterilization procedure between 2020 and 2022 with continuous insurance coverage within the previous year. Exclusion criteria were patients who had a hysterectomy, a history of tubal ligation, or acquired absence of genital organs, as well as ovarian or fallopian tube disorders, cancer or elevated risk for cancer, and missing data on the surgeon. The primary outcome for this study was receiving OS as a method of sterilization for patients and OS rate for clinicians, both in individuals and among peers. A total of 4520 patients had a postpartum sterilization procedure between 2020 and 2022, and 3376 had an interval sterilization procedure. Neither population of surgeons used OS at baseline. Of the postpartum patients, 353 received OS, and of the interval patients, 902 received OS. Physician networks explained 22.4% (95% CI: 11.9%-32.2%) of variation in OS use in postpartum sterilization procedures and 31.6% (95% CI: 21.8%-40.3%) of variation in OS use in interval sterilization procedures. Compared with patients whose surgeons had peers in the lowest range of OS use, those whose surgeons had more peer physicians with a higher rate of OS received OS at a higher rate ( P < 0.001 for both postpartum and interval samples). These results remained significant after adjustment for confounders. More recent years of surgery, higher BMI, a northeastern location, and undergoing cesarean delivery were associated with higher odds of undergoing OS. If the surgeon had a larger surgical volume and was based in a southern location, patients were at the lower end of receiving OS. These results indicate that physician peer influence promotes and/or impedes OS uptake. This is consistent with recent literature showing that interpersonal connections can affect clinical decision-making and uptake of other recent innovations in medicine. Both clinical and nonclinical factors play a role in this phenomenon, indicating there are likely also other variations that may be rooted in access to resources. Future research should focus on prospective designs to assess similar outcomes, as well as accounting for confounding variables that could not be addressed here and expanding beyond the data from one insurer. (Summarized from 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: https://doi.org/10.1001/jamanetworkopen.2025.32998)
L. Van Le (Sun,) studied this question.