Managing your Ovarian Cancer Risk

How do I manage my risk of Ovarian Cancer?

Risks associated with BRCA gene alterations for a 20y old woman with one first degree relative affected by ovarian cancer

Risks associated with BRCA gene alterations for a 20y old woman with one first degree relative affected by ovarian cancer

If you have inherited an alteration in BRCA1 or BRCA2 , your risk of ovarian cancer is greatly increased compared to the average woman. The exact risk depends on a number of factors, including the gene, the specific alteration, your age, and your family history.

Broadly speaking, the risk of ovarian cancer for a woman with a BRCA1 alteration is between 40-60%. The majority of this risk is for those women over the age of 40. The risk of ovarian cancer for a woman with a BRCA2 alteration is between 10-30%, and the majority of this risk is after the age of 50 years. 

Controversies in Ovarian Cancer Screening

Unfortunately, to date, no screening test has been proven to detect ovarian cancer at an early enough stage to improve survival in women with BRCA gene alterations. Much research to date has focused on the utility of a marker (CA125) that can be detected in the blood. This protein is often secreted by ovarian cancers, and is therefore commonly elevated in the blood of women with ovarian cancer. However, not all ovarian cancers produce this marker. Furthermore, the levels of this marker can be increased in women with other gynaecological issues. At the present time, we do not have enough evidence to recommend routine use of CA125-based screening for ovarian cancer. Recent studies have suggested that using this marker in combination with a transvaginal ultrasound, and taking into account a woman's age, BRCA mutation, and menopausal status, may help detect ovarian cancer at an earlier stage. However, there is not yet enough evidence that this approach might detect ovarian cancer at an early enough stage to allow curative treatment.

Therefore, at the present time, we recommend that women with BRCA1 or BRCA2 alterations consider risk-reducing ovarian surgery, by removing ovaries and fallopian tubes, to manage the risk of ovarian cancer. This is typically recommended at approximately the age of 40 years for carriers of BRCA1 alterations. Because the cancers in BRCA2 alteration carriers tend to occur at later ages, this surgery may be deferred until the age of approximately 45 years in such women. 

In the video below, Dr Michael O'Leary explains how to manage your risk of ovarian cancer in more detail. 

The decision to undergo risk-reducing ovarian surgery, and indeed the time at which it should be undertaken, is a difficult one. This surgery has a significant impact on fertility and family planning, and brings on an early (premature) menopause, which can be associated with negative consequences. In the next video here below, Dr O'Leary discusses how this surgery impacts your risk of cancer, how it impacts your health otherwise, and how you can manage the impact of premature menopause.