Managing hereditary ovarian cancer

In this review we present an overview of recent developments in the management of hereditary ovarian cancer. Until recently, intensive screening of the ovaries was recommended to mutation carriers and their first-degree female relatives. However, since screening is not effective in detecting early-stage ovarian cancer, women are counselled for a prophylactic bilateral salpingo-oophorectomy (pBSO) shortly after child-bearing age (>35 years). Many mutation carriers already choose to undergo pBSO to reduce their cancer risks; however, the age of prophylactic surgery may interfere with reproductive and other important (psychosexual) issues in life. Due to the protective effect of oral contraceptives regarding ovarian cancer, we advise women at increased risk of ovarian cancer to use oral contraceptive pills for 3-5 years early in life (<25 years of age), when the absolute incidence of breast cancer is extremely low. A transient increased relative risk of breast cancer due to oral contraceptives at this age will result in a negligible increased absolute number of breast cancers, while the risk reduction of ovarian cancer remains for life. Research should aim at finding new molecular markers and screening strategies for detecting early-stage ovarian cancer in women with a hereditary ovarian cancer trait.