Ovarian cancer risk counseling: a guide for the practitioner

Epithelial ovarian cancer is the most common gynecologic cancer diagnosed in women in the United States, with over 20,000 newly diagnosed cases per year. Over 70% of these patients present with advanced, stage III or IV disease, resulting in more than 13,000 deaths each year. This figure is all the more tragic given the long-term disease-free survival of approximately 85% for early stage disease. The natural history of the disease is poorly understood but is characterized by an insidious onset with vague, non-specific symptoms (which are commonly overlooked), and a high but often transient response to current surgical and chemotherapeutic approaches. It is commonly associated with a prolonged and painful death accompanied by repeat bowel obstructions, malnutrition, and immunologic compromise. In addition to the pain and suffering and loss of life of those affected with the disease, there is a profound and long-lasting impact on the entire family who experience the loss.