Ovarian intraepithelial neoplasia and ovarian cancer.

Ovarian cancer accounts for only 4% of cancers in women, but it is the leading cause of death from gynecologic malignancies in the United States. In the general population, a woman's lifetime risk of ovarian cancer is 1.4% but this risk can increase substantially in women with a strong family history of the disease. The high mortality rate from ovarian cancer is due primarily to the difficulty in detecting the disease in early stages; the disease tends to be asymptomatic until it is well advanced. The primary care physician needs to be alert to the possibility of an ovarian malignancy in all women with an intact ovary or ovaries who present with abdominal or pelvic complaints. There are no current recommendations for routine screening for ovarian cancer in the general population. Even in high-risk women, there are currently no convincing data to support extensive screening, although a number of studies looking at this issue are under way. Despite this lack of conclusive evidence, a consensus panel on ovarian cancer convened by the NIH recently issued guidelines for screening high-risk women. They recommend annual rectovaginal pelvic examination, testing of CA 125 level, and transvaginal ultrasonography. Color flow Doppler analysis of the ovarian vessels is also being studied as a possible screening modality. BRCA1 gene testing may soon play a role in women with a strong family history of the disease. Given its high mortality rate, primary prevention strategies for ovarian cancer should be used whenever possible. Oral contraceptive use appears to reduce the risk of ovarian cancer. Prophylactic oophorectomy may be suggested for women at particularly high risk of the disease. Here, too, the primary care physician can play an important role in helping a patient understand the risks and benefits of these options.