O varian cancer is the second most common gynecologic malignancy in the United States, exceeded in frequency only by endometrial cancer. In 1994, about 24,000 new cases of ovarian carcinoma were diagnosed and 13,600 women died of the disease. The main reasons for this dismal outlook are the absence of symptoms in early-stage disease, lack of readily recognizable and detectable precursor lesions, and the absence of specific and sensitive screening tests. Ovarian tumors can arise from epithelial, stromal, or germ cells and can also result from metastatic disease. Risk factors include age over 40, nulliparity, and a personal or family history of ovarian cancer or cancer of the endometrium, colon, or breast.
Recent evidence linking the use of fertility drugs to ovarian cancer remains controversial.
In women who have a family history of ovarian cancer, the relative risk of development of the disease is increased twofold to 20-fold. This risk varies with number of affected first-degree relatives. In a woman with one affected first-degree relative, the lifetime risk of dying of ovarian cancer is about three times greater than in the general population. All of the tests fall short of ideal because of the low prevalence of the disease, the lack of a detectable preclinical phase, and the low specificity, sensitivity, and positive predictive value of the tests. However, as a single screening test, transvaginal sonography has low specificity and has not made a significant impact on survival.