Ovarian cancer risk assessment and consideration of genetic testing

The following people warrant a referral to the NZ Family Cancer Service

UNTESTED adult blood relative of a person with an identified mutation in an ovarian cancer predisposition gene (e.g. BRCA1, BRCA2 gene, MLH1, MSH2, MSH6, PMS2, STK11).

Tumour pathology

• Invasive nonmucinous, epithelial ovarian, fallopian tube or primary peritoneal adenocarcinoma (regardless of age)
• Certain rare ovarian tumours (e.g. ovarian sex cord tumour with annular tubules (SCTAT), SertoliLeydig cell tumour, small cell ovarian carcinoma hypercalcaemic type, ovarian fibroma, ovarian leiomyoma)

For those with a personal history of cancer

• Invasive nonmucinous epithelial ovarian, fallopian or primary peritoneal cancer where there is also a personal history of breast cancer (regardless of grade and age)
• Invasive nonmucinous epithelial ovarian, fallopian or primary peritoneal cancer where there is Jewish ancestry (regardless of grade and age)
• Invasive nonmucinous epithelial ovarian, fallopian or primary peritoneal cancer (regardless of grade and age) where there is one or more close relative* with; a) ovarian cancer b) breast cancer
• Invasive epithelial ovarian cancer (regardless of age, grade and histological type) where there is one or more close relative* with;
  a) colorectal cancer under the age of 50 years
  b) endometrial cancer under the age of 50 years
• Personal history of invasive epithelial ovarian cancer (regardless of age, grade and histological type) and a second Lynch syndrome associated cancer
• Personal history of invasive epithelial ovarian cancer AND a family history of 1 or more 1st or 2nd degree relatives with colorectal or  endometrial cancer, with at least one of the cancers diagnosed under the age of 50 years
• Personal history of invasive epithelial ovarian cancer AND a family history of 2 or more 1st or 2nd degree relatives with a Lynch syndrome associated cancer regardless of the age the cancers were diagnosed

For those with a family history of cancer

• Close relative* with invasive nonmucinous epithelial ovarian, fallopian or primary peritoneal cancer diagnosed at any age where there is one or more additional close relative* with:
  a) epithelial ovarian cancer
  b) breast cancer
• Close relative* with invasive epithelial ovarian cancer (regardless of age, grade and histological type) where there is one or more close relative* with:
  c) colorectal cancer under the age of 50 years
  d) endometrial cancer under the age of 50 years
• Family history of 3 or more 1st or 2nd degree relatives with a Lynch syndrome associated cancer, regardless of the age the cancers were diagnosed

*close relative = 1st or 2nd degree

Lynch syndrome associated cancer includes adenocarcinoma of the colorectum, endometrium, small intestine, stomach, ovary, or pancreas, transitional cell carcinoma of the ureter or renal pelvis, cholangiocarcinoma, brain tumour, sebaceous gland tumours, keratoacanthoma.