Rapid Review Quiz: Ovarian Cancer Screening and Prevention
Reliably screening for ovarian cancer in the general population remains a challenge. Common tools such as CA-125 testing and transvaginal ultrasound have shown limited sensitivity and specificity, leading to unnecessary surgeries and false reassurance. However, advances in genetic testing and molecular pathology have reshaped prevention strategies, particularly in individuals at elevated hereditary risk such as BRCA mutation carriers.
Risk-reducing salpingo-oophorectomy remains the cornerstone of prevention for high-risk patients, while oral contraceptives offer a risk-reducing effect in the general population. Additionally, genetic counseling has become an essential step in identifying at-risk individuals who may benefit from tailored interventions.
How much do you know about recent developments in ovarian cancer screening and prevention? Test your knowledge with this updated review.
Despite significant research efforts, no screening strategy has yet demonstrated a mortality benefit in average-risk female patients. As noted in the National Comprehensive Cancer Network (NCCN) guidelines, landmark clinical trials — including the PLCO (Prostate, Lung, Colorectal, and Ovarian) cancer screening trial — failed to show a survival benefit from annual CA-125 testing or transvaginal ultrasound alone or in combination. The risk of ovarian cancer algorithm (ROCA) — which evaluates CA-125 trends over time — did improve early-stage detection rates but did not ultimately reduce mortality. As a result, current guidelines from the United States Preventive Services Task Force and other expert bodies, including the NCCN, recommend against routine screening for ovarian cancer in asymptomatic, average-risk females. Instead, attention has shifted toward identifying and managing high-risk individuals through genetic counseling and risk-reducing strategies. Routine screening in the general population is considered ineffective and may result in harms from false-positive tests and unnecessary surgical interventions.
Learn more about the workup for ovarian cancer.
Risk-reducing salpingo-oophorectomy (RRSO) remains the most effective strategy for preventing ovarian and fallopian tube cancer in individuals with BRCA1 or BRCA2 mutations. Guidelines recommend RRSO typically between ages 35 and 45, depending on the specific mutation and family history. This surgery significantly lowers the risk of high-grade serous carcinoma, the most common and aggressive subtype. Studies have shown that RRSO can reduce ovarian cancer risk significantly also confer a survival benefit, particularly in BRCA1 carriers. While oral contraceptives also reduce risk, they do not offer the same degree of protection as surgical removal of at-risk tissue. Annual pelvic exams and imaging have not demonstrated efficacy in early detection or mortality reduction in this population. Patients considering RRSO should be counseled about surgical menopause and may require hormone therapy depending on age and symptom burden. The procedure is essential in the preventive care of high-risk individuals.
Learn more more about ovarian cancer deterrence and prevention.
Emerging evidence over the past decade suggests that the fallopian tube epithelium — not the ovary — is the origin of many high-grade serous ovarian carcinomas. As a result, the practice of opportunistic salpingectomy — removing the fallopian tubes during hysterectomy or tubal sterilization procedures — has gained traction as a preventive strategy, even in females at average risk. Major gynecologic societies now endorse this practice as a safe and effective risk-reducing option during pelvic surgery for benign indications. The rationale is grounded in the theory of serous tubal intraepithelial carcinoma as a precursor lesion to high-grade serous cancer. Unlike endometrial cancer, whose origin lies in the uterine lining, salpingectomy directly targets the tissue where most serous carcinomas are thought to begin.
Learn more about ovarian cancer and surgical considerations.
Current guidelines recommend genetic counseling and consideration of BRCA and multigene panel testing in females with a personal or strong family history of breast, ovarian, fallopian tube, or peritoneal cancer. Identifying carriers of pathogenic variants enables implementation of life-saving risk-reducing strategies, including salpingo-oophorectomy or enhanced surveillance. Importantly, such testing is also offered to individuals with male relatives who have had breast cancer, early-onset cancers, or known mutations in cancer susceptibility genes. Genetic testing should ideally be preceded by counseling to interpret results accurately and discuss implications for family members. Patients with unrelated gynecologic conditions like endometriosis or abnormal uterine bleeding, and those without relevant family history, are not routinely offered genetic testing unless other risk factors emerge. Early identification of mutation carriers is essential for tailored management, timely preventive interventions, and cascade testing of at-risk relatives.
Learn more about risk assessment and genetic counseling in ovarian cancer.
Multiple large observational studies and meta-analyses have consistently demonstrated a protective effect of combined oral contraceptives (COCs) against ovarian cancer. The reduction in risk is observed with long-term use, typically over 5 years, and persists for decades after discontinuation. The proposed mechanism involves suppression of ovulation, thereby reducing the repetitive trauma and repair cycles to the ovarian epithelium, which may underlie carcinogenesis. The protective effect spans multiple histologic subtypes, including high-grade serous, endometrioid, and clear cell carcinomas. While other agents such as NSAIDs have been evaluated, their protective role is less well established and not considered standard for chemoprevention. Aromatase inhibitors and bisphosphonates are not used for ovarian cancer prevention. As with any medication, the decision to use oral contraceptives must consider individual risk profiles, including thromboembolic and cardiovascular risks, and be guided by patient preferences and shared decision-making.
Learn more about ovarian cancer and the impact of oral contraceptives.
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