General Medical Information

Ovarian Cancer Recommendations

Jonathan S. Berek

Current recommendations for management of women at high risk for ovarian cancer are summarized as follows :

1. Women who appear to be at high risk for ovarian or breast cancer should undergo genetic counseling and, if the risk appears to be substantial, may be offered genetic testing for BRCA1 and BRCA2.
2. Women who wish to preserve their reproductive capacity can undergo screening by transvaginal ultrasonography every 6 months, although the efficacy of this approach is not clearly established.
3. Oral contraceptives should be recommended to young women before they embark on a planned family.
4. Women who do not wish to maintain their fertility or who have completed their family may undergo prophylactic bilateral salpingo-oophorectomy. The risk should be clearly documented, preferably established by BRCA1 and BRCA2 testing, before oophorectomy. These women should be counseled that this operation does not offer absolute protection because peritoneal carcinomas occasionally can occur after bilateral oophorectomy.
5. In women who also have a strong family history of breast cancer, annual mammographic screening should be performed beginning at age 30 years.

   Women with a documented HNPCC syndrome should undergo periodic screening mammography, colonoscopy, and endometrial biopsy.