 Introduction/Background There has been much debate about the role of imaging in ovarian cancer screening based on currently available evidence [1]. Ovarian cancer has low disease prevalence, yet is the leading cause of mortality due to gynecologic malignancy in women in the United States [2]. It is estimated that there will be 22,440 new cancer diagnoses and 14,080 cancer deaths in 2017 [2]. The high mortality rate observed is largely due to late detection, as it is commonly discovered only after its widespread dissemination. Metastatic disease is present in 60% of cases at the time of diagnosis and is associated with a low 5-year relative survival rate of 28% [2]. Only 15% of women have organ-confined disease at the time of detection, and these women have a substantially higher 5-year relative survival rate (92%) [2], suggesting that screening could be of benefit if aggressive cancers can be reliably detected at earlier stages. The average lifetime risk for developing ovarian cancer for a woman in the United States is approximately 1.3% [2]. Women with certain risk factors are known to be at increased risk, including presence of BRCA1 or BRCA2 mutations, strong family history (ie, first-degree relative, particularly if premenopausal at the time of diagnosis), nulliparity, lack of breastfeeding, lack of hormonal contraception use, and postmenopausal status [9]. Among all risk factors, a genetic predisposition is associated with the highest increase in cancer risk. A recent meta-analysis projected that 20-year-old BRCA1 and BRCA2 mutation carriers have 39% and 16% mean cumulative risks of developing ovarian cancer, respectively, by age 70 [10]. At present, risk reduction in women with a strong genetic predisposition to ovarian cancer centers on bilateral salpingo-oophorectomy [11].
Ovarian Cancer Screening.  Introduction/Background There has been much debate about the role of imaging in ovarian cancer screening based on currently available evidence [1]. Ovarian cancer has low disease prevalence, yet is the leading cause of mortality due to gynecologic malignancy in women in the United States [2]. It is estimated that there will be 22,440 new cancer diagnoses and 14,080 cancer deaths in 2017 [2]. The high mortality rate observed is largely due to late detection, as it is commonly discovered only after its widespread dissemination. Metastatic disease is present in 60% of cases at the time of diagnosis and is associated with a low 5-year relative survival rate of 28% [2]. Only 15% of women have organ-confined disease at the time of detection, and these women have a substantially higher 5-year relative survival rate (92%) [2], suggesting that screening could be of benefit if aggressive cancers can be reliably detected at earlier stages. The average lifetime risk for developing ovarian cancer for a woman in the United States is approximately 1.3% [2]. Women with certain risk factors are known to be at increased risk, including presence of BRCA1 or BRCA2 mutations, strong family history (ie, first-degree relative, particularly if premenopausal at the time of diagnosis), nulliparity, lack of breastfeeding, lack of hormonal contraception use, and postmenopausal status [9]. Among all risk factors, a genetic predisposition is associated with the highest increase in cancer risk. A recent meta-analysis projected that 20-year-old BRCA1 and BRCA2 mutation carriers have 39% and 16% mean cumulative risks of developing ovarian cancer, respectively, by age 70 [10]. At present, risk reduction in women with a strong genetic predisposition to ovarian cancer centers on bilateral salpingo-oophorectomy [11].