Demographic shifts associated with implementation of evidence-based guidelines for ovarian conservation in patients with endometrioid endometrial cancer Journal Article


Authors: Manning-Geist, B. L.; Rios-Doria, E.; Aviki, E. M.; Zhou, Q.; Iasonos, A.; Abu-Rustum, N. R.; Brown, C. L.; Mueller, J. J.
Article Title: Demographic shifts associated with implementation of evidence-based guidelines for ovarian conservation in patients with endometrioid endometrial cancer
Abstract: Objective: In 2018, evidence-based surgical guidelines were introduced to identify appropriate patients with low-grade endometrioid endometrial cancer for ovarian conservation. We sought to identify trends and demographic shifts associated with guideline implementation. Methods: We identified women treated for endometrioid endometrial cancer at our institution from January 2010 to June 2021. Eligibility criteria included age ≤50 years, normal-appearing ovaries on preoperative imaging, no family history of hereditary breast and ovarian cancer syndrome or Lynch syndrome, and no hormone receptor-positive malignancy. Trends in ovarian conservation were examined with the Cochran-Armitage trend test or in a logistic regression model. Associations between ovarian conservation and clinicodemographic factors before and after guideline implementation were compared using Wilcoxon rank-sum and Fisher's exact tests. Results: Of 420 women ≤50 years of age undergoing surgery for endometrioid endometrial cancer, 355 (85%) met the criteria for ovarian conservation - 267 (75%) before and 88 (25%) after guideline implementation. Median patient age was 45 years (range 25-50); 62% were non-Hispanic White, 10% Hispanic White, 8% non-Hispanic Black, 0% Hispanic Black, and 20% Asian. Patients were significantly more likely to choose ovarian conservation after (48%) compared with before guideline implementation (21%) (p<0.001). Pre-guidelines, non-Hispanic White women were less likely to elect for ovarian conservation (12%) compared with non-Hispanic Black, Asian, or Hispanic White women (28%) (p=0.002). Similarly, older women were less likely to elect for ovarian conservation compared with younger women (p<0.001). There were no differences by obesity (p=0.68), marital status (p=0.86), or insurance (p=0.89). Post-guidelines, there were no differences in ovarian conservation between non-Hispanic White women (36%) and non-Hispanic Black, Asian, or Hispanic White women (50%) (p=0.56). Older women were still less likely to elect for ovarian conservationcompared with younger women (p<0.001). Conclusions: After guideline implementation, ovarian conservation increased and uptake disparities across demographic groups decreased. © 2022 IGCS and ESGO.
Keywords: surgery; uterine cancer
Journal Title: International Journal of Gynecological Cancer
Volume: 32
Issue: 9
ISSN: 1048-891X
Publisher: Lippincott Williams & Wilkins  
Date Published: 2022-09-01
Start Page: 1141
End Page: 1146
Language: English
DOI: 10.1136/ijgc-2022-003661
PUBMED: 35831030
PROVIDER: scopus
PMCID: PMC10428184
DOI/URL:
Notes: Article -- Export Date: 3 October 2022 -- Source: Scopus
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  1. Carol Brown
    167 Brown
  2. Qin Zhou
    254 Zhou
  3. Alexia Elia Iasonos
    363 Iasonos
  4. Jennifer Jean Mueller
    186 Mueller
  5. Emeline Mariam Aviki
    81 Aviki