STEP 1: Prevention and early detection

This step outlines recommendations for the prevention and early detection of ovarian cancer.

Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce cancer risk (Cancer Council Australia 2018).

The causes of ovarian cancer are not fully understood, and there is currently no clear prevention strategy.

Some factors that may reduce the risk of developing ovarian cancer:

  • using an oral contraceptive pill
  • giving birth and breastfeeding
  • surgical procedures such as tubal ligation, salpingectomy, hysterectomy and risk-reducing salpingo-oophorectomy.

Women and transgender men may be at risk of developing ovarian cancer.

The risk factors for developing ovarian cancer include:

  • ageing (risk increases for women and transgender men aged over 50)
  • tobacco smoking
  • obesity
  • family history of ovarian, breast or bowel cancer
  • mutations in genes such as BRCA1/BRCA2 or in Lynch syndrome–associated genes MLH1, MSH2/MSH6
  • being of Ashkenazi Jewish descent
  • early onset of periods (before 12 years) and late menopause
  • no history of pregnancy
  • infertility
  • women who have not had children or had their first child after the age of 35
  • never taking oral contraceptives
  • using oestrogen-only hormone replacement therapy or fertility treatment
  • medical conditions such as endometriosis

Everyone should be encouraged to reduce their modifiable risk factors, including taking the following steps.

Patients who may benefit from risk-reducing surgery include those with:

  • a potentially high risk of ovarian cancer – these patients should be referred to a familial cancer service for risk assessment, possible genetic testing and management planning (which may include risk-reducing surgery)
  • a high risk of ovarian cancer due to a confirmed gene mutation (surgery is recommended for these patients and should include complete removal of the extrauterine component of both the fallopian tubes and ovaries at a time considered appropriate after consultation with their treating clinicians)
  • a high risk of ovarian cancer due to confirmed Lynch syndrome (the surgery should include a hysterectomy and bilateral salpingo-oophorectomy at a time considered appropriate after consultation with their treating clinicians)
  • other less common mutations as deemed by a familial cancer service.

For patients who are considering risk-reducing surgery, the surgeon should provide:

  • a clear description of the risk-reducing surgery technique and clear information about the objective of the procedure
  • information about managing menopausal symptoms and other long-term side effects risk-reducing surgery as well as hormone replacement therapy use
  • a discussion about psychosocial wellbeing after risk-reducing surgery

Genetic counselling is appropriate for women who have:

  • a first- or second-degree relative with invasive epithelial ovarian, fallopian tube or primary peritoneal cancer and an additional first- or second-degree relative with one of the following:
    • epithelial ovarian, fallopian tube or primary peritoneal cancer
    • breast cancer
    • colorectal cancer under the age of 50 years
    • endometrial cancer under the age of 50 years
  • three or more first- or second-degree relatives with Lynch syndrome–associated cancer such as adenocarcinoma of the colorectum, endometrium, small intestine, stomach, ovary or pancreas, urothelial carcinoma of the ureter or renal pelvis, cholangiocarcinoma, brain tumour or sebaceous gland tumour (eviQ 2019a).

For more information see eviQ’s Referral guidelines for ovarian cancer risk assessment and consideration of genetic testing.

Population-based screening is not appropriate for ovarian cancer (Cancer Australia 2019b).