While these won’t stop you from developing ovarian cancer, there are a number of lifestyle related factors that can help lower your risk.
- Using the oral contraceptive pill
- Breast feeding, if you have the option
- Maintaining a healthy weight
- Eating a healthy, balanced diet
- Exercising regularly
- Not smoking
The National Breast Screening Programme offers all 50-70 year old women mammograms every three years on the NHS; make sure you attend your appointments. Unfortunately there is currently no national screening programme for ovarian cancer, but you can read about surveillance below.
Women with a BRCA1/2 gene mutation are offered yearly MRI scans, from the age of 30, to check for breast cancer. Surveillance isn’t routinely offered for ovarian cancer but it may be possible to have regular CA125 blood tests and pelvic ultrasound scans. Talk to your GP to find out what is available locally.
You may have the option of surgery to remove your ovaries and fallopian tubes, which will reduce the risk of cancer developing. As well as reducing your risk of developing breast cancer by 50%, having your ovaries and fallopian tubes removed (bilateral salpingo-oophorectomy) will reduce your risk of developing ovarian cancer to 5%.
This surgery may be offered in addition to a risk-reducing mastectomy, which will reduce your breast cancer risk further; to 5-10%.
Another option you may be given is to have a risk-reducing salpingectomy (removing the fallopian tubes only); as evidence suggests that the majority of BRCA1/2-associated cancers start at the end of the fallopian tube.
However, while evidence from the general population suggests that removing tubes approximately halves risk of ovarian cancer, there is no current evidence of safety or efficacy of this approach in women with BRCA1/2 gene mutations. Current research suggests that it offers less protection than removing the ovaries too.
Recent evidence suggests that women who have their ovaries and fallopian tubes removed, particularly those with a BRCA1 gene mutation, could be at a slightly higher risk of developing a very rare but aggressive form of serous endometrial cancer. With this in mind it is worth having a discussion with your GP or specialist about the risks and benefits of having a full hysterectomy when considering preventative surgery.
When should I have surgery?
If you decide to have surgery you will need to consider when is the best time. Age is the biggest factor and the below graphs look at how ovarian cancer risk changes with age in women with a BRCA1/2 gene mutation
In both cases, the graphs show no significant increased risk of ovarian cancer until age 45. If you have a BRCA1 gene mutation, risk increases at age 45-49 and again at age 55-59. Therefore, surgery is advised by age 40. Risk increases later if you have a BRCA2 gene mutation, so surgery can be left until you are in your mid-40s.
You will also need to consider the age your relatives developed ovarian or breast cancer and, because risk reducing bilateral salpingo-oophorectomy will make you infertile, whether or not you’ve completed your family. You can discuss all of these factors with your genetics counsellor before making a final decision.
These are NHS England guidelines (also followed in Wales). You can download a PDF of this guide containing NHS Scotland guidelines here. If you have any questions please contact Ross@ovarian.org.uk.