Ladies at increased risk of ovarian cancer
The majority of ovarian cancers are random spontaneous events but a small number run in families. The lifetime risk of ovarian cancer is around 1.4% in the general population, rising to 4-5% if one family member has had ovarian cancer and 7% if two have been affected. If the two relatives are first-degree relatives (ie mother, sister, daughter) lifetime risk is somewhere between 13-50%.
Ladies who have had breast cancer and who carry the BRCA 1 or BRCA 2 gene mutation have a lifetime risk of ovarian cancer of 35-46% and 13-23% respectively.
At present there is no proven, validated way of screening for ovarian cancer to allow earlier recognition and treatment. A very large study (UKC-TOCS) reported in the Lancet 2015, unfortuately did not show a reduction in mortality in ladies screened using Ca 125 and ultrasound scanning. Further work is however following on from this trial which may show benefit in the longer term. At present however one cannot recommend screening for ovarian cancer in the general population.
At present there are some lifestyle changes that are possible to reduce the risks including breast feeding, maintaining a healthy weight and possibly taking the combined oral contraceptive pill. Another option, if the risk is deemed high enough, is to have the ovaries and fallopian tubes removed before any disease is apparent. This is called risk-reducing surgery. In virtually all cases this can be done by keyhole surgery (operative laparoscopy) as a day case procedure. Such surgery reduces the risk of ovarian / fallopian tube / peritoneal cancer to around 0.04%. Incidentally, in ladies who carry the BRCA gene, this also reduces the risk of developing breast cancer by 30-75% as well.