Recommendations for high-risk populations, screening and prevention of ovarian cancer

High-risk objects
        1. Patients with hereditary breast cancer-ovarian cancer syndrome (ie BRCA1 or BRCA2 germline pathogenic variants or suspected pathogenic variants);
        2. Carry RAD51C or RAD51D or BRIP1 germline pathogenic variants or suspected pathogenic variants;
        3. Lynch syndrome (hereditary non-polyposis colorectal cancer syndrome) patients;
        4. First-degree relatives who are diagnosed with the above-mentioned hereditary tumor syndromes or carry the above-mentioned genes to cause disease or suspected pathogenic variants, but fail or refuse to be tested;
        5. Family history of ovarian cancer, breast cancer, prostate cancer, pancreatic cancer, or family history of endometrial cancer, colorectal cancer, and other Lynch syndrome-related tumors. After genetic counseling and risk assessment, it is recommended to accept genetic testing and fail or refuse testing. By;
        6. Have a significant family history of ovarian cancer and related tumors (multiple cases). Although genetic testing has been conducted, no known or suspected disease-causing genes have been detected in family patients (Note: current genetic testing and Data interpretation still has limitations).
 
Screening recommendations
        1. It is not recommended to screen for ovarian cancer in asymptomatic, non-high-risk women.
        2. It is recommended that the above-mentioned high-risk women who have not undergone preventive fallopian tube-oophorectomy surgery should be regularly screened for early detection of ovarian cancer. However, there is currently no evidence that ovarian cancer screening can bring clinical benefits to high-risk women.
        (1) According to the judgment of clinicians, high-risk women from 30 to 35 years old can consider receiving regular ovarian cancer screening;
        (2) Screening items: serum CA-125 examination and transvaginal ultrasound examination;
        (3) Screening interval: once every 3 months to once a year.
        3. In addition, women who have experienced abdominal distension, abdominal pain, irregular vaginal bleeding and other uncomfortable symptoms are not included in the scope of screening and should seek medical treatment as soon as possible for clinical evaluation.
 
Prevention advice
        1. Individuals who need further genetic testing after genetic counseling and risk assessment should be tested as soon as possible to clarify the risk of cancer;
        2. High-risk women who carry pathogenic variants or suspected pathogenic variants that increase the risk of ovarian cancer should preventively remove their ovaries and fallopian tubes at the appropriate age to reduce the risk of ovarian cancer;
        3. In theory, any behavior that allows the ovaries to stop ovulating within a period of time can reduce the risk of ovarian cancer, such as birth control pills, pregnancy, and breastfeeding. Therefore encourage timely childbirth and breastfeeding;
        4. After genetic counseling, some high-risk women can choose short-term oral contraceptives to reduce the risk of ovarian cancer (long-term use may increase the risk of breast cancer);
        5. For high-risk women of childbearing age, discuss possible genetic blockade with tumor genetic counseling doctors and reproductive doctors before giving birth;
        6. Maintain good living habits, regular work and rest, a reasonable diet, reduce the consumption of high-fat and high-cholesterol foods, and strengthen physical exercise.