Screening

Asymptomatic population

Current evidence does not support routine screening for ovarian cancer in the general population.[108][109][110][111][112][113][114][115]​​​

The US Preventive Services Task Force and the American College of Obstetricians and Gynecologists recommend against screening asymptomatic women at average risk for ovarian cancer.[116][117]​​

Screening for women at high risk

The effectiveness of routine screening for high-risk women has not been demonstrated; early-stage disease is difficult to detect and may be missed with pelvic examination, CA-125 testing, and transvaginal ultrasound.[66] Careful discussion between patient and physician is necessary to understand the significant limitations of these approaches, even in high-risk populations.[66]

A careful personal or family history may identify patients at increased risk of ovarian cancer who should be offered genetic risk assessment (including counselling and genetic testing).[16][17][77][78][79][80]​ Criteria for genetic risk assessment may include:[16][17]

  • Blood relative with a known pathogenic or likely pathogenic variant in an ovarian cancer susceptibility gene

  • Personal history or strong family history of breast and/or ovarian cancer (testing for BRCA1, BRCA2, ATM, BRIP1, PALB2, RAD51C, RAD51D, and mutations associated with Lynch syndrome [MSH2, MLH1, MSH6, PMS2, EPCAM])

  • Personal history of a Lynch syndrome-related cancer or strong family history suggesting Lynch syndrome, (e.g., a first-degree relative with colorectal and/or endometrial cancer with diagnosis at age <50 years, or with a synchronous or metachronous Lynch syndrome-related cancer, or with additional first- or second-degree relatives with related cancers).

Germline testing for a specific pathogenic variant can be carried out, if known; tailored germline multi-gene panel testing is recommended if the variant is unknown, based on personal and family history.[16][64][76]​​

If germline testing is positive, cascade testing (counselling and testing of blood relatives of individuals identified with a specific genetic mutation) should occur in a timely manner.[80]

Risk-reducing salpingo-oophorectomy (RRSO; with or without concomitant hysterectomy) is recommended on completion of childbearing for high-risk patients.​[16][17]​​ See Primary prevention.

High-risk women who decline or are unable to have RRSO

Routine screening (surveillance) with transvaginal ultrasound and CA-125 is sometimes considered for these high-risk women.[18][62][65]​​​ However, studies do not show a clear benefit and it is not routinely recommended.[16][17]​​

The Risk of Ovarian Cancer Algorithm (ROCA) may have potential utility as a surveillance tool in high-risk women (e.g., with pathogenic germline BRCA1/2 variants) who defer or decline risk-reducing surgery.[67]​

In the UK, National Institute of Health and Care Excellence (NICE) guidelines recommend considering surveillance with longitudinal CA125 testing (every 4 months) using an algorithm (such as the ROCA) for patients in the following high-risk groups who defer or decline risk-reducing surgery:[64]​

  • BRCA1 pathogenic variant and age over 35 years

  • BRCA2 pathogenic variant and age over 40 years

  • RAD51C, RAD51D, BRIP1, or PALB2 pathogenic variant and age over 45 years.

In addition, an annual review with discussion of risk-reducing surgery is recommended for these patients.

Surveillance of women at high risk of ovarian cancer represents an interim measure and should not be considered as an alternative to risk-reducing surgery.[68]

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