Family history of ovarian cancer: risk, genes and when to ask for advice

Ovarian cancer starts in the ovaries or the nearby fallopian tubes. The NHS explains that anyone with ovaries can get it, that the risk rises with age and that most cases in the UK are in women over 50.

Cancer Research UK says that we do not know what causes most ovarian cancers, but some risk factors increase the chance. One is a family history. Having a first-degree relative, meaning a mother, sister or daughter, diagnosed with ovarian cancer increases the risk. Another is inheriting a gene change, which can run through several generations and through either the mother's or father's side of the family.

Ovarian cancer is also connected to breast cancer in families. The NHS lists a personal history of breast or bowel cancer among its risk factors, and the same inherited BRCA genes can raise the chance of both breast and ovarian cancer, which is why doctors ask about both when taking a family history.

Cancer Research UK lists several gene faults that can raise ovarian cancer risk: BRCA1 and BRCA2, RAD51C, RAD51D, BRIP1 and PALB2. It also names two genetic syndromes, Lynch syndrome and Peutz-Jeghers syndrome, that increase the chance of ovarian cancer and some other cancers.

A gene fault is not the same as a diagnosis. The charity points out that having one of these faults means you are more likely to get ovarian cancer than someone who does not, but it is not a certainty. Many people who carry such a change never develop the disease.

The NHS says a GP may refer someone with a family history to a specialist for genetic testing. The aim is to find out whether a known fault runs in the family, because that information can guide risk-reducing options and allow relatives to be offered testing too.

Family history sits alongside other factors. The NHS lists starting periods early, having a late menopause after 55, not having had a baby, never having used hormonal contraception, taking hormone replacement therapy, being overweight and smoking, as well as endometriosis, diabetes and radiotherapy for a previous cancer.

Cancer Research UK adds that the combined contraceptive pill reduces risk, that the reduction lasts for at least 30 years after stopping, and that having children and breastfeeding also appear to lower risk. It notes that HRT slightly increases risk and that the increase is small, so the benefits of HRT may outweigh the risks for many people.

The NHS also points out that it is still possible to get ovarian cancer after the ovaries have been removed, because the cancer can also affect the fallopian tubes or the lining of the tummy.

The NHS says symptoms of ovarian cancer include frequently, roughly 12 or more times a month, having one or more of the following:

• A swollen tummy or feeling bloated.

• Pain or tenderness in the tummy or the area between the hips.

• No appetite or feeling full quickly after eating.

• An urgent need to pee or needing to pee more often.

The NHS notes that these symptoms are very common and have many causes, but should still be checked. The GP will ask about your health and family history, may examine you and may arrange a blood test for a protein called CA125. If the level is high, an ultrasound scan of the abdomen and pelvis follows. The NHS says an urgent referral, usually within 2 weeks, may be made if the symptoms could be cancer, and that this does not definitely mean you have cancer.

If the blood test and scan suggest ovarian cancer, you are referred to a gynaecological cancer service for further tests, which may include a CT scan, a needle biopsy, a laparoscopy or surgery. A team including a clinical nurse specialist looks after you throughout.

The NHS adds that sometimes ovaries are too small to show up on a scan, especially after the menopause, and that if your scan is normal but symptoms continue or become more frequent you should go back to the GP.

The NHS advises quitting smoking, staying at a healthy weight and talking with a GP if ovarian cancer runs in your family. For those found to carry a high-risk gene, a specialist team can discuss risk-reducing options in detail, including surgery, and the timing is usually tailored to age and family plans.

Because there is no national screening for ovarian cancer, awareness of symptoms is the main safeguard. Private tests, such as CA125 blood tests or scans offered without symptoms, are not part of the NHS pathway, and Cancer Research UK explains there is no test that reliably detects ovarian cancer early, so a normal private result should not be taken as full reassurance.