Familial ovarian cancer risk — DRCOG MCQ

Correct answer: E — Refer for genetic risk assessment

The best answer is “Refer for genetic risk assessment”. Early ovarian cancer in a first-degree relative plus early breast cancer in the family suggests possible hereditary breast and ovarian cancer syndrome, so genetic risk assessment is appropriate. CA125 surveillance in primary care is not a substitute for genetics referral. Cervical screening does not assess ovarian cancer risk. The pearl is that family history may matter even when the patient is asymptomatic. The key distinction is between an investigation suitable for initial risk stratification and a finding that already meets an urgent suspected-cancer pathway. Persistent symptoms, postmenopausal bleeding, a suspicious mass or relevant family history must not be dismissed by one reassuring test. Referral and subsequent imaging or tissue diagnosis answer different stages of the pathway.

Reference: NICE CG122: Ovarian cancer recognition and initial management: https://www.nice.org.uk/guidance/cg122/chapter/recommendations