FAMILIAL OVARIAN CA: WHEN TO SCREEN
JOSEE PILON, MD, of Gloucester, Ont., asks: "What's the recommended screening for a woman with a strong family history of ovarian cancer (first and second degree relatives with ovarian cancer mortalities in their 40s and 50s)?"
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.