There aren't any completed randomized prospective studies to answer your question about the best screening approach to such patients. Personally, I'd suggest referring your patient to a familial cancer clinic for family mapping and counselling to be tested for the carrier gene first. If the patient has a strong family history but the gene testing is negative, or if the patient doesn't want to have a genetic screen done, then I'd recommend annual transvaginal ultrasounds, CA-125 screening and biannual pelvic exams. Young women should be offered the oral contraceptive pill as a potential risk-reducing agent. For the general population, annual screening with ultrasound and CA-125 isn't cost-effective. An annual pelvic examination should be done regardless of risk.