Ovarian Colorado

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Identifying High Risk Women

The most important risk factor for ovarian cancer is a positive family history. It is estimated that 5-10% of ovarian cancer is caused by a gene that conveys a high degree of susceptibility. When such a gene is present in an individual, each of his or her children has a 50% risk of inheriting the gene, and thus the increased risk for cancer. However, because the gene is associated with a predisposition for cancer, a person could carry the gene, be unaffected, and still pass the gene on to his or her offspring, who might develop cancer. Some of these genes have been identified, and testing is available. In other families, this inheritance pattern, called autosomal dominant, is present, but the gene responsible for the increased cancer susceptibility has not yet been identified.

Factors that increase the risk for ovarian cancer include:

• Aging (median age at diagnosis is approximately 60 years of age in the general population)
• Personal history of breast, colon or endometrial cancer
• A family history of ovarian cancer, breast cancer or both breast and ovarian cancer at a young age
• Being of Eastern European Jewish (Ashkenazi) heritage and having a family history of breast or ovarian cancer
• Never having given birth
• Never having used oral contraceptives
• Obesity and sedentary lifestyle
• Carrying a known BRCA1 or BRCA2 mutation

The Importance of Family History

Because there are no reliable screening tests for ovarian cancer, and because a positive family history is a significant risk factor, obtaining a detailed and accurate family history becomes the most important tool for identifying women at risk. The family history should include at least three generations and should note any occurrences of cancer on the maternal and paternal sides. The family history should not be limited to patients, parents and grandparents, but rather should document all of the patient’s children, siblings, aunts, uncles and cousins. It is important to note both affected and unaffected relatives, so that the inheritance pattern can be inferred. The type of cancer and age of onset should be documented. It is also very important to review and update the family history annually. The best way to evaluate the family history is by constructing a pedigree, which visualizes the relationships in the family and distinguishes between affected and unaffected individuals.

Findings that suggest a familial cancer syndrome include:

• The occurrence at a young age
• Occurrence in the usually unaffected gender, such as breast cancer in a male
• Vertical transmission in a family (parent to child through the generations)
• Multifocal or bilateral disease
• Multiple primary cancers
• Clustering of unusual or rare cancers

Three or more affected first or second degree relatives on one side of the family.

Have Your Patients Fill Out a Simple Questionaire

http://www.myriadtests.com/quiz.htm

There are two sample family history questionnaires that a clinician might use in his or her practice as a first step in risk assessment. One is a general screening tool and the other is a more in-depth cancer history guide for the patient to complete, when there is a positive family history of cancer. Unfortunately, many individuals do not know or are misinformed about the cancer history in relatives. Medical records should be obtained whenever possible to confirm a diagnosis. If an increased risk is identified, she should be offered genetic counseling and a formal risk assessment.

You can also review the Family History Form.

Current information on prevention of ovarian cancer is summarized by the National Cancer Institute in the Ovarian Cancer (PDQ®): Prevention.

Risk Reduction

Factors that have been shown to reduce the risk of ovarian cancer include:

• Use of oral contraceptives (50% reduction and protection persists for 10-15 years after discontinuing use)
• Having at least one liveborn child
• Having breastfed an infant
• Bilateral oophorectomy (for women with a known inherited mutation)

Factors that may reduce the risk:

• Tubal ligation
• Hysterectomy
• Low fat diet