Next Gen in 10: The Promise of Risk-Reducing Salpingectomy

Next Gen in 10 is back! 🎙️ In this episode, Sabrina sits down with Dr. Alex Lukey, a registered nurse and recent PhD graduate whose work is shaping the future of ovarian cancer prevention. Alex walks us through her research on the acceptability and feasibility of risk-reducing salpingectomy (RRS), shares what she learned from interviewing OBGYNs, and reflects on the ethical, clinical, and equity considerations that come with offering RRS to people at moderate risk. She also discusses her prediction model designed to support informed decision-making — and the big questions she’s excited to explore next. Tune in for a clear, thoughtful look at where ovarian cancer prevention is heading.

Resources:

1. Lukey A, Sowamber R, Huntsman D, et al. Evaluating Ovarian Cancer Risk–Reducing Salpingectomy Acceptance: A Survey. Cancer Research Communications. 2025;5(1):187-194. doi:10.1158/2767-9764.CRC-24-0566

2. Lukey A, Howard AF, Mei AJ, et al. Risk-reducing salpingectomy: considerations from an OBGYN perspective. BMC Cancer. 2025;25(1):1011. Doi:10.1186/s12885-025-14384-6

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Transcript

00:00:02 Intro 

Thanks for listening to the GOSH podcast—The Gynecologic Oncology Sharing Hub. We share real, evidence-based discussions on gynecologic cancers, featuring stories from patients, survivors, researchers, and clinicians. Our podcast is produced and recorded on traditional unceded territories of the Musqueam, Squamish, and Tsleil-Waututh Nations. It is produced by the Gynecologic Cancer Initiative, a BC-wide effort to advance research and care for gynecologic cancers. 

00:00:35 Sabrina 

Hi everyone! My name is Sabrina, and I would like to welcome you back to our new segment on the GOSH Podcast called Next Gen in 10 where we feature GCI trainee research. Today we are joined by Dr. Alex Lukey, a registered nurse who recently completed a PhD in population and Public Health from UBC under the supervision of Drs. Michael Law and Gillian Hanley. Outside of her research, Alex serves on the Advisory Committee of the Women’s Health Research Cluster and teaches in both the undergraduate and graduate nursing programs at UBC Okanagan. Alex’s PhD dissertation focused on evolving strategies for ovarian cancer prevention, exploring the acceptability and feasibility of risk-reducing salpingectomy. Welcome to the podcast, Alex. 

00:01:24 Alex 

Thank you so much for having me. 

00:01:26 Sabrina 

Thank you for joining us. How are you doing today? 

00:01:29 Alex 

I'm doing great. How are you? 

00:01:31 Sabrina 

Good. I'm doing well. So I was thinking, could you start by telling our listeners a bit about the background of your research topic and sort of the gap that your research aims to fill? 

00:01:42 Alex 

Yeah, absolutely.So you read off the title of my thesis, which has lots of big words in it. So I'll try and break it down and make it a bit more simple. So basically the headline of my dissertation was working on ovarian cancer prevention and trying to take a prevention intervention that we know works and expand it to the right people. We know that most ovarian cancers actually start on the fallopian tube, which is the tube between your ovaries and uterus, that the only biological function of it is for pregnancy, basically. So we know most ovarian cancers actually start on the fallopian tube, not on the ovary itself. And this led to a really important prevention opportunity. So, about 15 years ago, right here in British Columbia, a team started to ask the question, if somebody is going in for another surgery, like a hysterectomy, or if they want permanent contraception, should we actually take the fallopian tube out? So should we actually take out the tissue that is where these really deadly cancers start? So that was called opportunistic salpingectomy. So that means that taking out fallopian tubes if somebody doesn't want any future pregnancies at another surgical opportunity. So that's been done for about 15 years or so, and it took that long to develop safety data to make sure it actually works so we can actually see that it reduces cases of ovarian cancer. And again, particularly the highest risk, which is the high grade serous, which starts on the fallopian tube. But this is only done if someone happens to be going in for another surgery. So what we're starting to ask is if you have an increased level of lifetime risk of ovarian cancer, should we actually be doing this as a standalone surgery? So not when someone is going in for another surgery, but actually doing it on its own. So the work that I did for my dissertation was getting perspectives from the general public, from OBGYNs, and then doing some safety data on actually expanding this intervention beyond just an opportunistic setting. 

00:03:50 Sabrina 

Very interesting. Can you give our listeners an example of someone who might be higher risk than a general public and might be eligible for surgery like this? 

00:03:59 Alex 

Yeah, absolutely. So it's important to note, too, I think, there's also people at an extremely high risk of ovarian cancer. So I think we've previously talked about it on this podcast, but people with what are called genetic variants like the BRCA variant, their lifetime risk of ovarian cancer can be as high as in the 40% range, which is extraordinarily high. You're almost getting to a flip of a coin. So those people, standard practice right now, when they reach a certain age, and if they don't want future pregnancies, they actually have their ovaries and fallopian tubes removed. So that's really important to distinguish those people from the people we're talking about. And then not the people at average or below lifetime risk, but people with, for instance, really strong family histories, but don't have these genetic variants might have a double or triple lifetime risk compared to average population risk, which would work out to somewhere around a 3 to 5% lifetime risk. So those are really the people we're talking about and that what we're calling this risk reducing salpingectomy. So people that are well above average risk that, you know, we're looking at a one in 20 chance of an extremely deadly cancer. And we have a prevention intervention that we can offer to these people, but not people at that very, very high risk level where we already have guidelines in place to offer those folks prevention. 

00:05:21 Sabrina 

Okay, thank you for that clarification. So super interesting research. What were your sort of overarching research questions or your objectives that you were trying to answer? 

00:05:32 Alex 

Yeah, so under this umbrella of the work that I did as part of my PhD, and again, this is just one snapshot. There's so many people doing amazing work in this area, but we really did four studies. So one was wanting to understand, again, these terms, acceptability and feasibility. So we wanted to know what are the people in the general public think. So this is always going to be something that's offered for prevention. It's always going to be completely patient driven in the sense that patients have to opt into this. They have to want this. So we first of all looked at would people from the general public who are at risk of ovarian cancer, is this something they would consider doing? Because it's a big deal to undergo surgery. So if we are saying, hey, you're at increased risk of ovarian cancer, would you do this? And if the answer is no, there's not really much point in doing much more research on this. We have to know that this is something people would want if it were offered to them. So we did a survey of the general public. We also wanted to understand from the provider perspective, right? So mainly OBGYNs, the people who would actually be doing this surgery. So we wanted to understand from their perspective, what are the things that would make this work? What are the issues that could come up in their practice? Are they already seeing this in their practice? So we did what's called qualitative interviews, which is really just over Zoom or over the phone interviews with OBGYNs to talk this concept through. We also wanted to better understand what the complication rate of this would be. So really, really key, especially because this is a prevention intervention, the risk and benefit balance has to be there, right? So if the risk of the surgery is too high, again, we're not going to offer this as a prevention opportunity for people. So we looked in our provincial databases to better understand if this were to be offered at a wider scale, what would that complication rate be? And then finally, a little bit more experimental work, but we wanted to see if we could do some prediction modeling. So actually using that same data to see, can we actually identify the people who are at increased risk using these provincial databases? So those were the four studies that I worked on over the last few years. 

00:07:38 Sabrina 

Okay, very interesting. I think you mentioned a little bit there sort of the methodology that you were using to answer all of these 4 different questions. But do you want to elaborate it all a little bit more on sort of what the overarching methods were for your study? 

00:07:54 Alex 

Yeah. So without getting like too technical. This is what we call multi methods research. So, mixed methods research is really usually combining what we call like the quantitative, so usually survey based or some sort of quantitative database and qualitative, which is like what we're doing here today, where we're talking to people, you're having these back and forth conversations in some way. So mixed methods is where you have those two pieces really combined and really inform each other. For this, we're using what's called multi-method, which is where you're doing research that includes both qualitative and quantitative, but they're not as closely linked. But again, this was to really, we chose multi-method to understand these large questions of feasibility and acceptability. So acceptability from both the provider side and from the patient side, and then feasibility using those population-based data sets to understand the complication rate and see if we could find people. So choosing the right kind of method to answer the right kind of research questions. So that's why we chose to use all those different kinds of methods to get at these questions from different angles. 

00:09:03 Sabrina 

Yeah, that makes total sense. So you did a lot of work in this PhD, obviously. Do you want to share with us some of your most important findings or the most significant ones? 

00:09:14 Alex 

Yeah, sure. So I'll kind of go one by one with the headlines of each of the studies that we found. So again, with this overarching question of risk reducing salpingectomy or selfingectomy to prevent ovarian cancer, where do we go from here, right? Where do we go from this opportunistic model? Should we expand it? So regarding acceptability from the patients who did the survey with us, we found that just over half of them would actually opt into this at less than a 5% lifetime risk, which we actually found a little bit surprising because depending on how people understand their lifetime risk, we were expecting patients maybe to find it acceptable, but at higher lifetime risks than what we as the research team think might be appropriate. So to say that over half of the people that at least took our survey are kind of in agreement with us around what lifetime risk they think this would be worthwhile is really interesting. 

00:10:09 Sabrina 

And just to clarify, what is the general life, like for the general population, what's the lifetime risk of ovarian cancer compared to that 5% that you received? 

00:10:19 Alex 

Yeah. So in Canada, it's about 1.3%. So, you know, a little bit simpler, you know, for every 100 people, about one person in their lifetime would get ovarian cancer. So, you know, for people where we think, this might land in terms of being worthwhile, it would be more in that five people out of every hundred or so, which is significantly elevated, but it still sounds low. So depending on how people understand it, it was a bit surprising that we found that a lot of people would still opt into a surgical prevention. Yeah, so that was probably the biggest, most interesting finding from the patient side. From the provider side, again, really positive, I would say, in general about this idea. They really talked about how horrible of a disease it was. They talked about their own experiences of having to manage this with patients, the diagnosis, and just a really strong desire to offer prevention if we have the opportunity to do it. But that it has to make sense, not just from the patient level, so balancing those risks and benefits, but also from the health system level, right? You know, they talked about instances where people currently with cancer are on wait lists and wait times that are really just too long and not hitting those guidelines. So wanting to make sure that this the risk benefit balance is there also from the health system perspective. So that's some ongoing work that needs to be done to understand where is that threshold of risk that makes sense from a health system perspective. But one thing that was really interesting that came up with the health care providers is that how we're defining risk reducing salpingectomy is actually already happening in practice and that patients are requesting this. So not really commonly, but we've heard it enough times to think that this is something that is happening not on a one-off basis, like this is definitely happening already, is that either patients hear about salpingectomy as a prevention method and ask their physicians for it or it's coming up where patients are being offered this in practice. So kind of an interesting thing to say that even though this isn't something that's currently in the guidelines or currently recommended, how we're defining risk reducing salpingectomy is already starting to happen in practice. 

00:12:36 Sabrina 

Very interesting. Yeah, that's such a cool finding. 

00:12:41 Alex 

And then for I think the other two studies are maybe a little bit less exciting, but more of a confirmation. So regarding the complication rate, so this is a really important piece for having the conversations between doctors and their patients. So over the past, you know, we can look back to studies that look at complication rates of permanent contraception. So this would be you're getting your tubes tied, so tubal ligation, or salpingectomy specifically for the indication of contraception. And really what we were able to find, first of all, is that, again, we are seeing that risk reducing salpingectomy is happening even in the provincial data. Rarely, like we're talking in the hundreds of cases, but it's there. So how we figure that out is by looking at the indication code. So it'll say this person got a salpingectomy for prevention without any other codes attached to it. So we have to infer that that's essentially how we're how we're defining risk reducing salpingectomy. So we were able to compare that to risks of people getting salpingectomies for things like contraception. So the headline there is that the historical rates of complications for any of these other kind of tubal contraception surgeries, it's really similar. So I think that can be something that providers can take and move forward with in those counseling conversations. 

00:14:05 Sabrina 

Okay. And then the last study, anything exciting? 

00:14:09 Alex 

Yeah, I mean, so that one was interesting. That one's the only, so the first two are fully published. They're actually open access and I'd be happy to share the links. The third one is under review, hopefully out soon. The fourth one is not published yet. So I'm a little bit more cautious with that one. But I will say that from what we've learned so far with that is just how important it is to take into account histotype. So I mentioned it earlier in the podcast that there is the most deadly type of ovarian cancer, which is hybrid serious cancer, is what we know self angectomy works for. So there's five total histotypes of ovarian cancer. So oftentimes in prediction studies in the past, most of them lump them all together. But what we actually know is that histotypes actually act almost like different diseases. They have different prognoses, they have different risk and protective factors. They look different from a biological perspective. So what we were finding in our prediction work is that when you separate the histotypes, so when you specifically look at an outcome of high-grade serous cancer, that the prediction models actually perform better than lumping them all together. And that's an important finding, which is different from the current literature. So I don't know that we necessarily reached a level of prediction where we would say, yeah, we're just going to use this model to go find all these people who should be offered risk reducing salpingectomy. But there were still important findings for this work in general. 

00:15:37 Sabrina 

Well, we will look forward to seeing that publication come out eventually. So can you tell me a bit about what brought you to this field and what made you interested in focusing on ovarian cancer prevention? 

00:15:52 Alex 

Yeah, absolutely. So I was really excited to work on ovarian cancer prevention as an overall topic because it really fit within a couple of themes that I'm really passionate about for research and healthcare in general. So when I was deciding what kind of topics to do for my PhD, I'm really excited about it, interested in women's health. I just find it's an area that's been so underfunded and underemphasized in research historically. So I knew I wanted to work something related to women's health. And then I'm also really passionate about prevention. So anytime you can prevent disease, it's just so much more effective. And it's just, it's exciting because although people don't necessarily know that outcome is avoided from both the personal perspective and from a health system perspective, it's just so powerful. So when I had the opportunity to work with Dr. Gillian Hanley, and she is one of the world's leading experts on opportunistic salpingectomy, we were having discussions about what I would work on for my PhD. Talking about salpingectomy, I found really interesting because it really is on this cutting edge of ovarian cancer prevention. And not only that, but developed by a team right here in BC to work on such an exciting prevention intervention that was developed right where I'm doing my PhD. And with such a fantastic team that hits these themes that I'm really excited about. It just really seemed like such a great fit to be able to push that evidence one step further to, yeah, just take an intervention that we know is so powerful and make sure the right people have access to it. So yeah, it was a combination of fit with the team and having good fit with some of the themes that I wanted to work on for my research. 

00:17:42 Sabrina 

Yeah, I totally resonate with everything you just shared. And I would say that the team was very lucky to have you being the one doing this important research as someone with very extensive qualitative and quantitative skills. 

00:17:54 Alex 

Yeah, well, thank you. The gynecologic oncology team in BC is just fantastic. So it's a privilege to work with them. 

00:18:01 Sabrina 

Fantastic. So your findings suggest that risk-reducing self-ingectomy could be safe and acceptable for these people who might be at moderate risk. How do you see that translating into real-world clinical practice? And do you foresee there being any barriers or challenges to this expansion? 

00:18:20 Alex 

Yeah. So I think one thing I'll start with clarifying is that the way I'm looking at these studies, we aren't proving that this should be happening yet. But what we are doing is laying the foundation for further research to recommend this. But with that said, I will say that some of the findings are translatable to clinical practice right now. So as I said, it sounds like people are coming into their doctor's offices and actually already asking for this, which is really interesting. So I think what this work does, both the quantitative and qualitative, sides of it is that it can support doctors when people are coming in and asking for this. So again, at this stage, we're not really saying that this should be offered to people. It's not on the guidelines. It needs a little bit more work yet. But when if you have a patient come into your office and want to open up that discussion about salpingectomy specifically for the for the indication of ovarian cancer prevention. So they're not asking for this as permanent contraception, they're worried about cancer prevention. I think this will be informative to, whether it's a family physician or OB-GYN, especially the complication rate piece. I think that can be translated right away to have a little bit more confidence when you're having those conversations about what we would expect that complication rate to be when you're counseling a patient. And then also the pieces where the qualitative work with other OB-GYNs I think some of those findings can also inform those decisions in terms of what are your colleagues thinking about this? How are we wanting to approach these conversations given the evidence where it's at? So I think where the findings of this work can be used right now in clinical practice is in those scenarios where you have a patient who's actively seeking salpingectomy for ovarian cancer prevention. So, and the rest of it would be to stay tuned and watch for developments in terms of being more proactive in offering this. But as we've seen, there's already cases where I think some of this work is definitely useful. 

00:20:26 Sabrina 

Okay, thank you for clarifying. I think that makes total sense. I've also heard you speak about this topic before, and I've heard you mention that in interviews with your OBGYNs, things came up about patient autonomy and equity and health system burden. And I'm curious how those conversations sort of shape your perspective on the ethical side of offering risk reducing salpingectomy. 

00:20:50 Alex 

Yeah, this is such a huge conversation. And I think we really just scratched the surface of it in those interviews. But I think it's so important to bring up, particularly Canada's history of forced and core sterilization of different populations, especially Indigenous and institutionalized people. So It's a dark side of our history, but as recent as 2018, there have been reports of coerced sterilization that happen. And salpingectomy is a really unique intervention in the sense that it's a cancer prevention intervention, but it also provides permanent contraception. So it is absolutely essential that there is fully informed consent and that patients are the ones driving this there is absolute respect for their reproductive autonomy, and that goes both ways. So both in the sense that if they are seeking permanent contraception, that they're able to access that. And on the flip side of that, that there is absolutely no scenario where someone is feeling like they are being coerced or that they're trying to be persuaded to undergo this kind of procedure. So unlike other cancer prevention things that we might do, like the HPV vaccine, like where it's a vaccine, there's no other effects. This is a really unique intervention in the sense of how important it is to have that informed consent because there is a really important secondary effect. And for some people, that is a very welcome and beneficial effect, but especially if we talk about where this could be proactively offered to people. There are some really important ethical and patient autonomy pieces that must be respected and figured out before this is something that is offered in practice. So this is actually a little some work that I'm on a grant with the Canadian Cancer Society doing some work around this. So, but this isn't something that this has to be top of mind whenever we're discussing this kind of intervention is ensuring that it's delivered in a culturally safe and equitable way. We have to be informed by those histories. So that was something that OBGYNs brought up around autonomy and equity. But also really, I think on the maybe more positive side was just how strong the OB-GYNs were in their opinions that they really wanted to support their patients in these decisions and these really important decisions that they wanted to be able to provide them the care that patients are requesting. So if patients are seeking this kind of cancer prevention, that they really want to be able to support them in that decision. So it goes both ways, both in being able to offer it when people want it and ensuring that no one is ever in a situation where they're either not understanding what they're being provided or that they're being persuaded or coerced into receiving a salpingectomy. So it's a really unique and really important conversation when we talk about cancer prevention in this space. 

00:23:59 Sabrina 

Yeah, yeah, that's such an important reflection and thing to come out of these qualitative interviews that you certainly wouldn't get from quantitative research. So also an important part to be for an important example of why it's important to have both of these parts of research when we're looking at acceptability and feasibility. 

00:24:19 Alex 

Yeah, like you said, the qualitative pieces, I always think I'm a big proponent of qualitative work because as a research team, you can sit down and think of the survey questions you want to ask or think about what topics you think are important. But until you talk to people who are on the front lines of in this scenario, ovarian cancer prevention, you're not going to think of all the things that need to be thought about because you're not the one providing that care. So I'm a huge supporter of doing qualitative work. 

00:24:45 Sabrina 

One last follow up question on your research. So you developed this prediction model in your final study to support discussions around risk reducing self injectomy. What do you see as the next steps for that tool? And more broadly, what's the next big question you're excited to explore in that area? 

00:25:04 Alex 

It was, I mean, personally, it was a really great experience just learning to do the prediction work. I think it's just the best way to learn those skills is to do a project on it. So it was a great experience in terms of learning how to create a prediction model and seeing what that actually can look like in the population data. One thing I will plug just because I think it's important to know about is that there is already an individual tool called CAMRISK that is validated and it's used in clinical practice. So at an individual level, there is already a tool available that can be used by clinicians to evaluate a patient's lifetime risk. But the difference with that tool and what we were doing is that. In order to complete CAN risk, you have to be sitting down with a patient and you have to be able to ask them questions that you can't find in administrative data, which was what we were using for our prediction model. So one thing is I'll just kind of plug that there is already a prediction tool available that if you're sitting down with a patient and you want to better understand their lifetime risk, it's just a click through. There's, you know, have you been on the oral contraceptive pill? Do you have a family history of breast cancer or ovarian cancer, which is great and it's available. So, what we were trying to do was trying to say, could we take that one step further and actually find people within a population? Not that you have to already be sitting in your doctor's office and have them already be assessing your wearing cancers. Can we be a bit more proactive with it? So in terms of some important learnings from that, I think I already mentioned the importance of taking histotype into consideration. So as of right now, CANRISK actually doesn't take histotype into consideration. So, we're actually, there's some work where we're considering working with that team to potentially think about that. But in terms of what's kind of next for that, we're doing some comparisons with some American data and more trying to take those learnings of, well, what does this mean for tools that already exist rather than possibly making a brand new tool, which is totally fine. And that's sometimes what happens with PhD work is where you think it might go one way and it goes a different way, but that there's still some potentially clinically important findings from that. 

00:27:14 Sabrina 

To wrap up, we always ask our trainees, if you could only say one thing to everyone that would listen to this podcast about your field of research, what would you say? 

00:27:24 Alex 

Yeah, I think one thing that I've been thinking about a lot, and so outside of my PhD work, we're actually doing some qualitative work with people that took the survey and then we're actually giving them their lifetime risk scores. And so getting a more in-depth patient perspective. One thing that's been coming up is just this real lack of awareness around ovarian cancer. So I think we've done a really good job of spreading awareness for different cancers like breast cancer, where people are aware of it. It's in their mind. They know that they're supposed to go get their mammograms right. But ovarian cancer is just really not top of mind for people, I think, maybe in the general public, where they know they don't know that they could they have prevention opportunities available to them. So I think one thing that I think we could start now is just increasing awareness around ovarian cancer and particularly the fact that we do have this intervention that we know reduces the risk of ovarian cancer. So people can't ask for something that they don't know about. So I think, again, coming back to that piece around patient autonomy and people being able to make the decision that's right for them of whether or not this is something that they think would have a meaningful effect on their health, is that I just think people need to know about it. And as we've said, there are people who are already asking for that if they're aware of it, but you have to have a pretty high level of involvement and education around healthcare, I think, to have this in your awareness just because it's so new and it's not something that's been widely available for very long. So I think one piece right now is just both from the provider and from the general public side is just spreading awareness so that people can advocate for themselves if they think it's right. And from the provider side, you know, making sure that they're offering patients, especially if there's an opportunity for self-anjectomy, like they're already undergoing a surgery, to make sure that we're capturing all those opportunities. So I think at this stage, the biggest takeaway, I think right now where we could go is just increasing awareness. 

00:29:27 Sabrina 

Yeah, fantastic. I think that's a great call to action that many people are working on, but we can certainly work harder to make sure everyone has that information. Perfect. Well, thank you so much for joining us on the podcast today. This has been a lovely conversation, and I can't wait for all our listeners to hear. 

00:29:44 Alex 

Thanks so much, Sabrina. Thank you for having me. It's been an absolute pleasure. 

00:29:48 Outro 

Thanks for joining us on the GOSH Podcast. To learn more about the Gynecologic Cancer Initiative and our podcast, make sure to check out our website at gynecancerinitiative.ca.