Which risk factors should I consider when assessing a patient's likelihood of having ovarian cancer?

When assessing a patient's likelihood of having ovarian cancer, several key risk factors should be considered. Family history is paramount; having a first-degree relative with ovarian cancer or a maternal/paternal second-degree relative diagnosed with ovarian cancer significantly increases risk, warranting genetic counselling and testing for pathogenic variants such as BRCA1/2 mutations ¹. Genetic predisposition is critical, with pathogenic variants in genes linked to ovarian cancer (including those associated with Lynch syndrome) elevating risk; tools like CanRisk can help quantify this risk by integrating age, family history, and genetic data ¹.

Age is another important factor, with risk increasing notably in women aged 50 years and over, especially when symptoms suggestive of ovarian cancer persist ²,³. Reproductive history influences risk; parity (number of pregnancies) and use of combined oral contraceptives can modify risk, with contraceptive use generally reducing ovarian cancer risk but potentially increasing breast cancer risk, necessitating careful consideration ¹.

Clinical symptoms such as persistent abdominal distension (bloating), early satiety, pelvic or abdominal pain, and urinary urgency/frequency, especially if occurring more than 12 times per month in women over 50, should prompt investigation ³,⁴. Endometriosis is also recognized as a risk factor that may not be fully captured by risk assessment tools ¹.

Other factors include personal history of ovarian or related cancers (e.g., ovarian Sertoli–Leydig cell tumour, small cell carcinoma of the ovary hypercalcaemic type), which necessitate germline testing ¹. Additionally, conditions like polycystic ovary syndrome (PCOS) may indirectly influence risk through associated hormonal and metabolic changes, although the direct link to ovarian cancer risk is less clear ⁵.

In summary, the main risk factors to consider are genetic predisposition (family history and pathogenic variants), age (especially over 50), reproductive factors (parity and contraceptive use), clinical symptoms, and certain gynecological conditions such as endometriosis ¹,²,³,⁴.