Ovarian Cancer Risk

When a woman is diagnosed with cancer, she needs to consider her family’s history of cancer. Some cancers are inherited; however, most are spontaneous. If there is a concern with a family pattern of cancer, then a thorough family history should be taken. Sometimes this leads to formal genetic counseling with blood testing for specific gene mutations. If you have a specific gene mutation putting you at risk for breast or ovarian cancer, then surveillance testing or procedures are different from those with a spontaneous cancer. Therefore, start with telling your oncologist your family history. I'm not sure what is standard, but my gynecologist is going to give me internal ultrasounds to check my ovaries yearly until I'm 40 years old. Then when I turn 40, the plan right now is to have my ovaries removed. Unless anything funny looks like it's going on, then they get pulled then. I should note I'm 32 right now, so that may change.
My breast specialist thought this plan was fine so we're running with it.

Breast and ovarian cancer survivors, especially those with, hormone-sensitive cancers, may worry about using ovarian stimulating hormones either during fertility preservation prior to cancer treatment or during survivorship. For fertility preservation purposes, embryo or egg banking are options for many young women. In this process, hormones are used to induce the ovaries to produce multiple eggs in one month (normally an ovary produces a single egg per month). Clinical hormonal stimulation protocols have been modified to work for women with hormone-sensitive cancers. The one study that looked at cancer recurrence rates for breast cancer survivors who underwent this procedure, found that these women did not have an increased risk for cancer recurrence compared to those who did not have ovarian stimulation.

Survivors of hormone-sensitive cancers may also discuss using this protocol with their fertility specialist. However, they may first wish to examine their ovarian reserve, the number of immature eggs in their ovaries, as chemotherapy, radiation, and surgery for cancer treatment may have significantly reduced this number.
Breast and ovarian cancer survivors, especially those with, hormone-sensitive cancers, may worry about using ovarian stimulating hormones either during fertility preservation prior to cancer treatment or during survivorship. For fertility preservation purposes, embryo or egg banking are options for many young women. In this process, hormones are used to induce the ovaries to produce multiple eggs in one month (normally an ovary produces a single egg per month). Clinical hormonal stimulation protocols have been modified to work for women with hormone-sensitive cancers. The one study that looked at cancer recurrence rates for breast cancer survivors who underwent this procedure, found that these women did not have an increased risk for cancer recurrence compared to those who did not have ovarian stimulation.

Survivors of hormone-sensitive cancers may also discuss using this protocol with their fertility specialist. However, they may first wish to examine their ovarian reserve, the number of immature eggs in their ovaries, as chemotherapy, radiation, and surgery for cancer treatment may have significantly reduced this number.

Having one gynecologic cancer does not increase your risk of having other types of gynecologic cancer. However, women with a hereditary cancer syndrome are at increased risk of developing a gynecologic cancer. These syndromes include Hereditary Breast and Ovarian Cancer (HBOC) caused by a BRCA mutation as well as Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC). Women with HBOC syndrome have markedly elevated risks of breast cancer and ovarian cancer, with a lifetime risk of breast cancer of 50 to 85 percent and a 15 to 40 percent chance of developing ovarian cancer. There is also an increased risk of a second breast cancer diagnosis.

Lynch syndrome is associated with cancer diagnosis at an early age and the development of multiple cancer types, particularly colon and endometrial cancer. Until recently, the majority of attention and research related to Lynch syndrome has focused on colorectal cancer. However, women with Lynch syndrome have a 27 to 71% risk of endometrial cancer, which equals or exceeds their risk of colorectal cancer. This is significantly higher than the 3% risk of endometrial cancer in the general population. In addition, women with Lynch syndrome have a 8-11% risk of ovarian cancer, compared with 1.5% in the general population. The management of endometrial and ovarian cancer risks in women with HBOC or Lynch syndrome includes surveillance, chemoprevention and risk-reducing surgery.
Having one gynecologic cancer does not increase your risk of having other types of gynecologic cancer. However, women with a hereditary cancer syndrome are at increased risk of developing a gynecologic cancer. These syndromes include Hereditary Breast and Ovarian Cancer (HBOC) caused by a BRCA mutation as well as Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC). Women with HBOC syndrome have markedly elevated risks of breast cancer and ovarian cancer, with a lifetime risk of breast cancer of 50 to 85 percent and a 15 to 40 percent chance of developing ovarian cancer. There is also an increased risk of a second breast cancer diagnosis.

Lynch syndrome is associated with cancer diagnosis at an early age and the development of multiple cancer types, particularly colon and endometrial cancer. Until recently, the majority of attention and research related to Lynch syndrome has focused on colorectal cancer. However, women with Lynch syndrome have a 27 to 71% risk of endometrial cancer, which equals or exceeds their risk of colorectal cancer. This is significantly higher than the 3% risk of endometrial cancer in the general population. In addition, women with Lynch syndrome have a 8-11% risk of ovarian cancer, compared with 1.5% in the general population. The management of endometrial and ovarian cancer risks in women with HBOC or Lynch syndrome includes surveillance, chemoprevention and risk-reducing surgery.

When the survivor has a deleterious mutation of the BRCA 1 or 2 gene that carries an elevated risk, or if ovarian cancer runs in the family. When the survivor has a deleterious mutation of the BRCA 1 or 2 gene that carries an elevated risk, or if ovarian cancer runs in the family.

In patients with the BRCA gene, ovarian cancer can occur in addition to breast cancer. The risk depends on which BRCA gene mutation they inherited, with BRCA 1 patients having a risk of ovarian cancer as high as 44% and BRCA 2 patients having a risk as high as 27%. For patients without the BRCA gene, the risk is much lower. Breast cancer can metastasize to the ovary, causing tumors called Krukenberg tumors. Years ago, before the advent of medications to suppress estrogen formation by the ovary, many oncologists requested that the ovaries be removed to reduce estrogen in premenopausal breast cancer patients. That is not really done anymore except in extenuating circumstances. At the moment, there is no specific protocol to monitor the ovaries of breast cancer survivors. Some gynecologists will not change their standard care and others will offer sonograms (ultrasounds) both to assess the uterine lining in patients taking Tamoxifen and to look at the ovaries. Sadly, as mentioned in other questions on this site, ovarian cancer can be sneaky and not show up on scans. My thought is to not worry too much unless you are BRCA positive. Please ask your doctor if you qualify for testing. In patients with the BRCA gene, ovarian cancer can occur in addition to breast cancer. The risk depends on which BRCA gene mutation they inherited, with BRCA 1 patients having a risk of ovarian cancer as high as 44% and BRCA 2 patients having a risk as high as 27%. For patients without the BRCA gene, the risk is much lower. Breast cancer can metastasize to the ovary, causing tumors called Krukenberg tumors. Years ago, before the advent of medications to suppress estrogen formation by the ovary, many oncologists requested that the ovaries be removed to reduce estrogen in premenopausal breast cancer patients. That is not really done anymore except in extenuating circumstances. At the moment, there is no specific protocol to monitor the ovaries of breast cancer survivors. Some gynecologists will not change their standard care and others will offer sonograms (ultrasounds) both to assess the uterine lining in patients taking Tamoxifen and to look at the ovaries. Sadly, as mentioned in other questions on this site, ovarian cancer can be sneaky and not show up on scans. My thought is to not worry too much unless you are BRCA positive. Please ask your doctor if you qualify for testing.

Great question. Not many. Most ovarian cancer just happens because of bad luck. Less than 25% of ovarian cancer is caused by an inherited identifiable genetic mutation. Certainly a patient with a family history of ovarian cancer should be evaluated to determine if she qualifies for BRCA testing. This can be done either by a formally-trained genetic counselor or by less-formally-trained healthcare providers who have been educated about risk assessment for various cancers including ovarian cancer. Ovarian cancer happens to about 1% of women with no risk factors. If a first degree relative has ovarian cancer, the risk goes up to 4%. If the patient has a BRCA mutation, the risk can be as high as 44%. With Lynch syndrome, a combination of uterine, colon, ovarian, and a few other cancers, the risk is between 10-15%. Women who have never had a baby, who had early menarche and late menopause, and who have never taken the pill are at slightly higher risk given that there ovaries never took a break from ovulating. There is controversy over whether "super ovulation" (using medications to increase the number of eggs ovulated) used in infertility patients increases the risk of ovarian cancer. Patients with any of these factors are evaluated regularly and advised to report any changes in bowel or bladder habits or pelvic symptoms that might be associated with ovarian cancer (see prior question). Great question. Not many. Most ovarian cancer just happens because of bad luck. Less than 25% of ovarian cancer is caused by an inherited identifiable genetic mutation. Certainly a patient with a family history of ovarian cancer should be evaluated to determine if she qualifies for BRCA testing. This can be done either by a formally-trained genetic counselor or by less-formally-trained healthcare providers who have been educated about risk assessment for various cancers including ovarian cancer. Ovarian cancer happens to about 1% of women with no risk factors. If a first degree relative has ovarian cancer, the risk goes up to 4%. If the patient has a BRCA mutation, the risk can be as high as 44%. With Lynch syndrome, a combination of uterine, colon, ovarian, and a few other cancers, the risk is between 10-15%. Women who have never had a baby, who had early menarche and late menopause, and who have never taken the pill are at slightly higher risk given that there ovaries never took a break from ovulating. There is controversy over whether "super ovulation" (using medications to increase the number of eggs ovulated) used in infertility patients increases the risk of ovarian cancer. Patients with any of these factors are evaluated regularly and advised to report any changes in bowel or bladder habits or pelvic symptoms that might be associated with ovarian cancer (see prior question).