The potential for risk stratification in the management of ovarian cancer risk.

Invasive epithelial ovarian cancer (EOC) is the most fatal malignancy of the female reproductive tract, causing more deaths than all other gynecologic cancers combined. Most cases are diagnosed at an advanced stage, and 5-year survival with EOC is less than 50%. Screening for EOC in the general population has not been found to be effective, with the recently reported results from the Prostate, Lung, Colorectal and Ovarian trial showing that there was no shift in the stage at diagnosis among the screen-detected cases and no reduction in mortality. Targeting screening at those at highest risk may prove to be more effective. An alternative approach to risk management is prophylactic surgery, which may be a useful option for women in the highest risk groups. In this article, I will summarize the current state of knowledge about ovarian cancer genetics and discuss how this knowledge may be used to target primary or secondary prevention in ovarian cancer.