Ovarian Cancer Risk Reduction: Understanding Your Options

Learning that ovarian cancer may run in your family can bring a lot of questions. You may wonder what “high risk” really means, whether you should be screened more often, or what you can actually do to lower your risk.

In this episode of Teal Talk – An Ovarian Cancer Podcast, the final conversation in NOCC’s Silent InHERitance series, we speak with Dr. Kara Long of Memorial Sloan Kettering and Dr. Rebecca Stone of Johns Hopkins. Together, they explain how ovarian cancer risk reduction is changing as researchers learn more about inherited cancer risk and the role of the fallopian tubes.

This conversation builds on the previous Teal Talk episode, BRCA and Beyond: Understanding Ovarian Cancer Genetic Testing, which explains inherited cancer risk, genetic counseling, and what genetic testing results may mean for you and your family.

Most importantly, increased risk does not mean that cancer is certain. Knowing more about your family history, genetic risk, and prevention options can help you make informed decisions with your healthcare team.

This article is for education only. It should not replace medical advice from your care team.

Love what you hear? Subscribe to Teal Talk – An Ovarian Cancer Podcast to hear more real stories, expert insights, and empowering conversations for survivors, caregivers, and advocates.

What does having a higher ovarian cancer risk mean?

Having a higher risk of ovarian cancer does not mean that you will develop the disease.

A risk factor is something that may increase your chance of developing cancer. Your individual risk can be affected by your age, family history, personal medical history, reproductive history, and inherited genetic changes. You can learn more about these factors in NOCC’s Ovarian Cancer Risk Factors guide.

For example, harmful inherited changes in BRCA1 and BRCA2 can increase the risk of ovarian, fallopian tube, breast, and other cancers. Other inherited gene changes and family cancer syndromes may also increase ovarian cancer risk.

According to the National Cancer Institute’s BRCA fact sheet, about 39% to 58% of people with a harmful BRCA1 change and 13% to 29% of those with a harmful BRCA2 change will develop ovarian cancer during their lifetime. However, a positive genetic test cannot tell whether or when an individual will develop cancer.

That is why knowing your family health history matters.

Dr. Long explained:

“So to me, the biggest thing is knowing your family history, talking to your doctor about your family history, seeing if genetic testing is an option, and then really having the knowledge about the fallopian tubes.”

Family history matters on both sides of your family. Inherited cancer risk can come from your mother or your father. NOCC’s Silent InHERitance resources can help you learn more about family health history, inherited cancer risk, and genetic testing.

If several relatives have had ovarian, breast, pancreatic, prostate, colorectal, or other related cancers, talk with your healthcare provider. A genetic counselor can help review your family history and explain whether genetic testing may be appropriate.

Why is ovarian cancer screening so difficult?

After learning they have a higher risk, many people have the same reaction: “Just screen me for ovarian cancer.”

Unfortunately, there is currently no reliable routine screening test for ovarian cancer.

Researchers have studied tools such as:

• CA-125 blood tests
• Transvaginal ultrasound
• Pelvic examinations

However, these tools have important limitations when used to screen someone without symptoms.

Dr. Long explained:

“And the other half had ultrasounds and blood tests, like CA-125 blood tests. And so disappointing to all of us, the screening did not work. So the group that had all the screening, they were just as likely to get sick and die from ovarian cancer as the other group. And so what we realized was that, for whatever reason, we had no available tools to catch this disease early enough.”

The National Cancer Institute explains that no effective ovarian cancer screening methods are currently known. Even in people with harmful BRCA1 or BRCA2 changes, CA-125 blood tests and transvaginal ultrasound have not been shown to find ovarian cancer early enough to improve long-term survival.

A Pap test does not screen for ovarian cancer either. Pap testing is used to screen for cervical cancer.

Therefore, it is important to understand the difference between screening and evaluating symptoms. Screening looks for cancer in someone without symptoms. If symptoms are present, a healthcare provider may use imaging, blood tests, and other information to determine what could be causing them. NOCC’s Ovarian Cancer Diagnosis guide explains how these tests may be used when ovarian cancer is suspected.

Which ovarian cancer symptoms should you pay attention to?

Because there is no reliable routine ovarian cancer screening test, knowing what is normal for your body is important.

Possible ovarian cancer symptoms include:

• Persistent bloating
• Abdominal or pelvic pain
• Trouble eating
• Feeling full quickly
• Changes in urination
• Changes in bowel habits
• Abdominal swelling

These symptoms are common and can have many causes other than ovarian cancer.

However, a symptom deserves attention when it is new, happens often, lasts, or gets worse.

Dr. Long described how she talks with patients about symptoms:

“But if you have a symptom that you cannot directly explain for any other reason and it sticks around for more than two weeks, I usually say, ‘Call your doctor.’”

For example, feeling bloated after a large meal and then feeling better is different from unexplained bloating that continues or keeps coming back.

Your personal risk also matters. If you have a strong family history or a known inherited mutation, tell your healthcare provider about new or persistent symptoms.

NOCC’s Ovarian Cancer Signs and Symptoms guide explains what to watch for and how to prepare for a conversation with your healthcare provider. It also includes NOCC’s symptom diary to help you track changes over time.

How can fallopian tube removal reduce ovarian cancer risk?

One of the biggest changes in ovarian cancer prevention has come from learning more about where some ovarian cancers begin.

Researchers now know that many high-grade serous ovarian cancers, the most common type, appear to begin in the fallopian tubes. Research summarized by the National Cancer Institute on the fallopian tube origins of ovarian cancer has helped change how specialists think about prevention.

However, not every ovarian cancer begins in the fallopian tube. Some epithelial ovarian cancers and less common types, such as germ cell and sex cord-stromal tumors, can begin in the ovary itself.

Dr. Stone explained:

“So now that we know that, the cancer that we really need to focus on preventing comes from the tube. We are increasingly talking about salpingectomy, which means to remove the fallopian tubes for prevention. And when you think about tubes versus ovaries, that conversation really depends upon what your risk is, right?”

A salpingectomy is surgery to remove one or both fallopian tubes.

What that means for ovarian cancer risk reduction depends on your individual risk level.

What about people at average risk?

For someone at average risk who has completed childbearing, a healthcare provider may discuss removing the fallopian tubes during another planned pelvic surgery. This is sometimes called an opportunistic salpingectomy.

For example, someone having a hysterectomy or choosing permanent contraception may be able to discuss fallopian tube removal.

The American College of Obstetricians and Gynecologists’ guidance on opportunistic salpingectomy states that removing the fallopian tubes during another pelvic procedure may reduce ovarian cancer risk. However, it does not eliminate the risk completely.

What about people with a BRCA mutation or another high inherited risk?

The conversation is different for people with a harmful BRCA1, BRCA2, or another inherited gene change linked to a high ovarian cancer risk.

For people at very high inherited risk, surgery to remove both fallopian tubes and ovaries, called risk-reducing salpingo-oophorectomy, is the most established and effective surgical approach for reducing ovarian cancer risk.

However, removing the ovaries before natural menopause causes surgical menopause. Therefore, timing should take into account the specific gene involved, age, pregnancy plans, personal health, and the potential effects of early menopause.

The National Cancer Institute’s BRCA risk-management information provides more information about risk-reducing surgery and the potential benefits and harms.

What about removing the tubes first and the ovaries later?

Researchers are studying whether some people at high inherited risk could remove the fallopian tubes earlier and delay removal of the ovaries until closer to natural menopause.

The goal is to reduce cancer risk while delaying the effects of surgical menopause.

However, researchers do not yet know whether this approach prevents ovarian cancer as well as removing both the fallopian tubes and ovaries.

For example, the NCI-listed SOROCk study is currently comparing salpingectomy with delayed ovary removal against the standard risk-reducing surgery in people with BRCA1 mutations. Another active trial is studying a similar strategy in people with several inherited ovarian cancer risk genes.

What else can you do to understand or reduce your ovarian cancer risk?

Ovarian cancer risk reduction is not about finding one lifestyle change that guarantees protection.

Family history and inherited genetics can play an important role. Therefore, some of the most useful steps involve understanding your risk and making informed healthcare decisions.

Start by:

• Learning your family cancer history
• Sharing that history with your healthcare provider
• Asking whether genetic counseling may be appropriate
• Understanding what your genetic test results mean
• Knowing the symptoms of ovarian cancer
• Discussing risk-reduction options based on your personal risk

If you are unsure where to begin, NOCC’s Ovarian Cancer Risk Factors page explains which factors may affect risk and what people at higher risk may want to discuss with their healthcare team.

Some reproductive and medical factors may also affect ovarian cancer risk.

For example, using birth control pills has been linked with a lower risk of ovarian cancer. This lower risk has also been seen in people with harmful BRCA1 or BRCA2 changes. Learn more from the National Cancer Institute.

However, birth control pills also have possible risks and side effects. Talk with your healthcare provider about what is appropriate for you.

Most importantly, developing ovarian cancer does not mean that someone made the wrong health choices.

Dr. Long shared:

“And I always spend a couple of minutes just saying, ‘Nope, there was no screening test that you missed. Doesn’t exist. There wasn’t anything you did wrong.’ And so I think it is important for our patients to know that these things just happen and we don’t always know why, but we’re trying to change that. We’re trying to empower women to at least have more choices to decrease their risk in their lives.”

The goal is not to look backward and search for something you should have done differently. Instead, information can help you make informed decisions moving forward.

Conclusion

Ovarian cancer risk reduction looks different for every person. Your family history, genetic test results, age, and personal health can all shape the choices available to you.

Most importantly, knowing that you have an increased risk can give you an opportunity to ask questions and make informed decisions. You do not have to navigate those decisions alone. NOCC is here with trusted education, resources, and support to help you understand your risk and your options.

Frequently asked questions about ovarian cancer risk reduction