This is a unique service screening women at risk of ovarian cancer due to a strong family history. A dedicated team, screen and monitor women and offer prophylactic surgery where required.
In the UK, there are approximately 6600 new cases of ovarian cancer and 7000 cases of endometrial cancer diagnosed annually. Of them, an estimated 5-10% may be the result of a familial predisposition.
Families at high risk of gynaecological cancers belong broadly to two groups:
- Those with a family history of breast or breast and ovarian or ovarian cancer alone who are at risk of carrying a BRCA 1 or 2 gene mutation
- Those with a family history of colorectal, endometrial, small bowel, ovarian, ureteric and renal pelvic cancers suggestive of Lynch Syndrome or hereditary nonpolyposis colorectal cancer(HNPCC) who may have a gene mutation in MLH1, MSH2, MSH6 and PMS2. In such families, cancers occur in more than one family member and usually through several generations.
Women from these families who are first degree relatives of those affected with cancers have a 10% or greater life time risk of ovarian cancer. In addition, Lynch syndrome women have a 25-60% lifetime risk of endometrial cancer.
In the clinic, all women undergo comprehensive risk assessment and counselling. Women confirmed to be at ‘high risk’ are offered a variety of risk management options which include:
- risk reducing laparoscopic surgery to remove the ovaries and tubes after a woman has completed her family. Usually such surgery is undertaken in the forties. In Lynch syndrome women with a significant risk of endometrial cancer, the uterus is also removed
- screening for ovarian and endometrial cancer (as appropriate)
- life style and contraceptive advice
- referral for breast or bowel screening as appropriate.
- referral to clinical genetics (for assessment and genetic testing if appropriate)
- Advice about the symptoms of ovarian cancer and management of those symptoms
It is not yet known whether gynaecological screening is effective and will save lives. Until 31 March 2010 eligible women opting for screening were recruited into the NCRN UK Familial Ovarian Cancer Screening Study (UKFOCSS). Recruitment to this trial is now closed and scheduled to report it's findings at the end of 2013.
Screening on the trial involves annual transvaginal ultrasound and 4 monthly serum CA125 testing. In addition, endometrial cancer screening using yearly transvaginal ultrasound scans and outpatient hysteroscopy & endometrial sampling is also available for women with Lynch Syndrome.
- Increased familial risk of ovarian/tubal and endometrial cancer