Ovarian cancer kills more women than any other gynaecological cancer in many countries — not because it is the most common, but because it is diagnosed late. Understanding who is genuinely at elevated risk is the first step toward the surveillance and risk-reduction strategies that can make a difference.

Dr. Shachi Singh, consultant gynaecologist at Prakash Hospital, Sector 33, Noida, explains ovarian cancer risk comprehensively.

---

Risk Factors: What Elevates Your Risk

1. Hereditary Risk (the most important category)

BRCA1 mutation: Lifetime ovarian cancer risk of 44 to 46%. The single biggest risk factor.

BRCA2 mutation: Lifetime ovarian cancer risk of 17 to 23%.

Lynch syndrome (HNPCC — Hereditary Non-Polyposis Colorectal Cancer): Caused by mutations in mismatch repair genes (MLH1, MSH2, MSH6, PMS2). Lifetime ovarian cancer risk approximately 10 to 12%. Also elevates risk of endometrial cancer (40 to 60% lifetime risk) and colorectal cancer.

Family history without identified mutation: Even without a known gene mutation, having one first-degree relative with ovarian cancer approximately triples lifetime risk. Two or more affected relatives increase risk further.

2. Reproductive and Hormonal Risk Factors

Nulliparity (never having been pregnant): Each completed pregnancy reduces ovarian cancer risk. Women who have never been pregnant have higher risk than those with children.

Infertility: Independently associated with slightly elevated ovarian cancer risk — the exact mechanisms are debated (persistent ovulation, underlying PCOS-related inflammation, endometriosis).

Endometriosis: Specifically associated with clear cell and endometrioid subtypes of ovarian cancer. Women with documented endometriosis have approximately 1.5 to 2 times the baseline ovarian cancer risk.

Late menopause (after 55): Prolonged ovulation over a longer reproductive life increases risk.

Early menarche (before 12): Slightly increases risk by extending the years of ovulation.

Postmenopausal hormone therapy: Oestrogen-only HRT (used in women without a uterus) is associated with a modest increase in ovarian cancer risk with prolonged use. Combined HRT (oestrogen plus progestogen) has less clear risk in most studies.

3. Factors That Reduce Ovarian Cancer Risk

Oral contraceptive pill: This is the single most effective risk-reduction factor outside of surgery. Combined OCP use reduces ovarian cancer risk by approximately 40 to 50%, with greater protection with longer duration of use. The protective effect persists for 20 to 30 years after stopping. This protective effect applies even in BRCA carriers, though it modestly increases breast cancer risk — a risk-benefit discussion.

Completed pregnancies: Each full-term pregnancy reduces risk by approximately 10 to 15%.

Breastfeeding: Associated with modest reduction in ovarian cancer risk.

Tubal ligation: Reduces ovarian cancer risk by approximately 30 to 40%. The fallopian tube is now recognised as the origin of most high-grade serous ovarian cancers — removing or occluding the tubes reduces this source.

Salpingectomy (bilateral fallopian tube removal): Increasingly offered as opportunistic risk reduction at the time of other gynaecological surgery (caesarean section, hysterectomy, sterilisation) — removes the most common site of high-grade serous cancer origin.

---

Who Should Consider Genetic Testing for Ovarian Cancer Risk

Genetic counselling and consideration of BRCA and Lynch syndrome testing is recommended for:

• Personal history of ovarian cancer (any epithelial, fallopian tube, or primary peritoneal cancer)
• First-degree relative with ovarian cancer
• Personal or family history of breast cancer diagnosed before 45
• Multiple family members with breast cancer across generations
• Family member known to carry a BRCA or Lynch syndrome mutation
• Personal or family history of both breast and ovarian cancer (in the same individual or family)
• Male relative with breast cancer
• Ashkenazi Jewish ancestry with any breast or ovarian cancer history
• Personal history of endometrial cancer before 50 (Lynch syndrome assessment)
• Family history strongly suggesting Lynch syndrome (colorectal cancers, endometrial cancer, across generations)

---

What Genetic Testing Involves

Genetic counselling is the first step — to assess pre-test probability, explain what results mean (positive, negative, variant of uncertain significance), and discuss implications for the woman and her relatives.

Testing itself is a blood sample. For ovarian cancer risk, the primary genes tested are BRCA1 and BRCA2 (in a BRCA panel) and the Lynch syndrome mismatch repair genes. Multigene panel testing (testing multiple hereditary cancer risk genes simultaneously) is increasingly available and used.

---

Risk Management for High-Risk Women

For women found to carry BRCA mutations, risk management is discussed in detail in the BRCA blog. Key points:

• Enhanced surveillance with MRI, ultrasound, CA-125
• Oral contraceptive pill for premenopausal women (risk-reducing benefit outweighs modest breast cancer risk increase in many situations)
• Risk-reducing bilateral salpingo-oophorectomy (RRSO) after completing childbearing — recommended at 35 to 40 for BRCA1 carriers and 40 to 45 for BRCA2 carriers

---

Gynaecological Care in Noida and Greater Noida

Dr. Shachi Singh at Prakash Hospital, Sector 33, Noida, assesses ovarian cancer risk, coordinates genetic counselling referral, and provides risk-reducing gynaecological surgery for women across Noida and Greater Noida.

To book a consultation with Dr. Shachi Singh, call: +91 97023 46853

Clinic Hours: Monday to Saturday, 9 AM – 6 PM | Sunday, 10 AM – 2 PM

Clinic Address: D-12A, 12B, Sector-33, G.B. Nagar, Noida, Uttar Pradesh 201301

---

This blog is written for educational and informational purposes only. Please consult Dr. Shachi Singh or a qualified genetic counsellor for personalised risk assessment.