Canadian Management of Serous Tubal Intraepithelial Carcinoma

The study by Spénard et al1 in the September 2025 issue reports real-world data on the diagnosis of serous tubal intraepithelial carcinoma and the subsequent risk of high-grade serous carcinoma from 15 Canadian centers. The authors observed a reduction in incidence after careful multicenter pathology review, underscoring the importance of diagnostic confirmation by expert pathologists. However, the estimated incidence was derived from a heterogeneous cohort whose baseline risks were influenced by ethnicity, willingness to undergo surgery, and national guidelines or reimbursement policies.2–4 This heterogeneity limits generalizability, and several statistical issues warrant clarification. First, the analysis of confounders using a Cox regression model for high-grade serous carcinoma incidence is clinically meaningful. Nonetheless, the small sample size, retrospective design, and limited number of events substantially reduced the robustness of the findings. This limitation also extends to variables that were not analyzed in the study, including parity, ethnicity, and hormone exposure.5 Second, the cumulative risk of high-grade serous carcinoma for the “correctly” diagnosed serous tubal intraepithelial carcinoma after multicenter pathology review cohort was calculated from one event at 73 months in a cohort of 45 patients. Intuitively, the risk should be 0% at 5 years (60 months) and 2.6% after 73 months, given six censored cases. This contrasts with the article's report of 2.6% at both 2 and 5 years and with Figure 2D, which shows one event at 12–24 months and another at 60–72 months. Clarification is needed regarding possible inclusion of additional data in the model. Third, the 5-year cumulative risk in the original 107-patient cohort was 5.7%, suggesting that “misdiagnosed” patients remained at risk. Additionally, reporting the number of patients who met inclusion criteria but had no serous tubal intraepithelial carcinoma would further clarify disease prevalence across risk groups. Overall, although defining the true cumulative risk of high-grade serous carcinoma from serous tubal intraepithelial carcinoma requires greater effort, the established benefits of risk-reducing salpingo-oophorectomy and prophylactic salpingectomy during benign surgery may warrant higher priority than an exclusive focus on pathology review. This approach could benefit patients and ease the workload of a declining pathology workforce.6 With more robust, standardized data, clearer insight into prevalence, risk, and optimal management will be possible.7