A 35-year-old woman comes to the office to discuss her risk of ovarian cancer. The patient recently read that women who have sex with women might be at increased risk of ovarian cancer. She has had only female sexual partners. The patient has no appetite changes, abdominal distension, pelvic pain, or abnormal vaginal bleeding. She is nulliparous and has never been on contraception.
The patient has no chronic medical conditions and has had no prior surgeries. She takes a daily multivitamin and occasional ibuprofen at the beginning of her menstrual periods. Family history is significant for a maternal aunt with postmenopausal breast cancer. The patient drinks 1 or 2 glasses of wine a night but does not use tobacco or illicit drugs.
Vital signs are normal. The lungs are clear to auscultation bilaterally. Cardiac examination reveals a regular rate and rhythm. The abdomen is soft, nontender, and nondistended.
Which of the following is the most appropriate ovarian cancer screening guideline for this patient?

Question

A 35-year-old woman comes to the office to discuss her risk of ovarian cancer.  The patient recently read that women who have sex with women might be at increased risk of ovarian cancer.  She has had only female sexual partners.  The patient has no appetite changes, abdominal distension, pelvic pain, or abnormal vaginal bleeding.  She is nulliparous and has never been on contraception.
The patient has no chronic medical conditions and has had no prior surgeries.  She takes a daily multivitamin and occasional ibuprofen at the beginning of her menstrual periods.  Family history is significant for a maternal aunt with postmenopausal breast cancer.  The patient drinks 1 or 2 glasses of wine a night but does not use tobacco or illicit drugs.
Vital signs are normal.  The lungs are clear to auscultation bilaterally.  Cardiac examination reveals a regular rate and rhythm.  The abdomen is soft, nontender, and nondistended.
Which of the following is the most appropriate ovarian cancer screening guideline for this patient?

Quizplus · Accepted Answer

11ec193a_97ed_203d_853d_0724339e214e_MD0002_00 Ovarian cancer usually presents with subtle symptoms (eg, bloating, pelvic pressure) but may present acutely (eg, bowel obstruction, abdominal pain). Unfortunately, most cases are diagnosed at an advanced stage and have poor survival rates (25% 5-year survival rate with stage 4). In comparison, survival improves with early stage of disease (>90% 5-year survival with stage 1). Presumptive causes of ovarian cancer include recurrent ovulation and increased gonadotropin levels; therefore, ovulation frequency determines both risk and protective factors (eg, parity, combined hormonal contraception [CHC]). Women who have sex with women (WSW) have some risk factors for ovarian cancer, including lower parity and lower use of CHC (ie, more frequent ovulation). However, they are still considered at average risk for ovarian cancer unless they have Ashkenazi Jewish ancestry, family history of premenopausal or male breast cancer, or BRCA mutation (ie, high risk). In low- or average-risk women, ovarian cancer screening is not recommended. (Choices A and E) Genetic testing should be offered to high-risk women (eg, Ashkenazi Jewish ancestry, family history of premenopausal or male breast cancer) with unknown BRCA1 and BRCA2 status. For those who are BRCA-positive, CA-125 levels are used to screen for ovarian cancer and to monitor ovarian cancer progression and recurrence. However, CA-125 may be elevated in benign conditions (eg, uterine fibroids, endometriosis) and therefore is not specific enough for average-risk patient screening. (Choices B and C) Transvaginal ultrasounds and pelvic examinations are sensitive only for advanced-stage ovarian cancer. Neither has been proved effective at screening for early-stage disease in low- or average-risk women. Educational objective: Women who have sex with women have risk factors for ovarian cancer (eg, low parity, low contraceptive use); however, despite these risk factors, they are still considered to be at average risk. Ovarian cancer screening in low- or average-risk women is not indicated. __________ References: Ovarian cancer prevention, screening, and early detection: report from the 11th Biennial Ovarian Cancer Research Symposium. (http://www.ncbi.nlm.nih.gov/pubmed/29278600) Towards prevention of ovarian cancer. (http://www.ncbi.nlm.nih.gov/pubmed/29295697)

A 35-Year-Old Woman Comes to the Office to Discuss Her