Epithelial ovarian cancer. Risk factors, screening and the role of prophylactic oophorectomy.

Epithelial ovarian cancer is the seventh most frequent cancer in European women. Many theories have been postulated regarding the pathogenesis of ovarian cancer. Risk factors are not well defined, with the exception of low parity and oral contraceptive use. Approximately 10% of ovarian cancer are hereditary, with BRCA1 and BRCA2 explaining the majority (approximately 90%) of hereditary ovarian cancer cases. The lifetime risk varies between 15 and 66%, suggesting the existence of modifying genetic or environmental factors.Family history can be used to define women who are at increased risk of ovarian cancer. Individuals at high risk are those with a first degree relative (mother, father, sister, brother, daughter or son) affected by cancer. It must be noted that currently available tests do not attain the aforementioned high level of sensitivity. Evidence suggest that presymptomatic screening by grey scale ultrasound (with or without Doppler), CA125, pelvic examination, or combinations of these, are not effective in detecting tumors at an early stage. Women identified as being at high risk of ovarian cancer can be offered prophylactic oophorectomy. The decision whether or not to proceed to prophylactic oophorectomy is influenced by the fact that most women at increased risk of ovarian cancer are also at increased risk of breast cancer and there is evidence that oophorectomy reduces breast cancer in these cases.