• Incidence of reported occurrences of breast, ovarian, fallopian tube, and peritoneal cancer 5 years after study completion [ Designated as safety issue: No ]
  
• Prevalence of clinically occult ovarian cancer and precursor lesions in prophylactically-excised ovaries and fallopian tubes by using standardized tissue processing and histological examination of surgical tissue after completion of accrual to the s ... [ Designated as safety issue: No ]
  
• Quantify the positive predictive value and specificity of the risk of ovarian cancer screening algorithm (ROCA) among women enrolled in the screening arm of this study by occurrence of ovarian, fallopian tube, and peritoneal cancer at completion of a ... [ Designated as safety issue: No ]
  
• Longitudinal serum, plasma, and tissue repository for biomarker studies and translational research projects by specific studies as sufficient materials are accrued within the repository [ Designated as safety issue: No ]
  

• Patterns of use of hormonal medications (MHT, SERMs, and bisphosphonates) in surgical and screening arm enrollees by the self-report of medication use at one year after study completion and additional analyses as appropriate [ Designated as safety issue: No ]
  
• Mortality and incidence of various diseases which complicate long-term estrogen deficiency (e.g., osteoporosis, skeletal fractures, coronary disease, myocardial infarction, and stroke) by self-reported medical history information questionnaire 5 year ... [ Designated as safety issue: No ]
  
• Adherence by study participants to recommendations made regarding the management of non-oncologic morbidity related to premature menopause by annual questionnaire at 2 and 5 years after study completion [ Designated as safety issue: No ]
  
• Decision-making with reference to cancer risk reduction and screening activities by custom-designed questionnaires administered at the time of study enrollment and at time of cross-over from screening to surgery arms of the study to the first 600 sub ... [ Designated as safety issue: No ]
  
• Normal ranges and distributions of high-risk women for CA-125 values over time stratified by menopausal status, MHT usage, surgical status, and other risk factors by combining data from 0199 and the CGN ROCA cohorts at conclusion of enrollment into ... [ Designated as safety issue: No ]
  
• Refine the ROCA algorithm by accounting for defined modifiers of CA-125 level as identified in prior analysis at study completion [ Designated as safety issue: No ]
  

OBJECTIVES:

Primary

• Compare the prospective incidence of ovarian cancer, breast cancer, fallopian tube cancer, primary peritoneal cancer, and all cancer in participants at increased genetic risk of ovarian cancer who undergo risk-reducing salpingo-oophorectomy (RRSO) or CA 125 screening.
• Determine the prevalence of clinically occult ovarian cancer and fallopian tube cancer and precursor lesions in participants who undergo RRSO.
• Determine the positive predictive value and specificity of the Risk of Ovarian Cancer Algorithm (ROCA) based on serial CA 125 measurements for ovarian cancer in participants who do not undergo RRSO.
• Compare quality of life, sexual functioning, frequency of menopausal symptoms, depression, anxiety, cancer worry, and concerns associated with familial risk of ovarian cancer in participants who undergo RRSO vs screening.
• Compare changes in these quality of life parameters over time in these participants.
• Establish a longitudinal serum, plasma, and tissue repository for the evaluation of promising biomarkers and genetic alterations with relevance to familial ovarian and breast cancer risk.

Secondary

• Determine patterns of use of medications (e.g., tamoxifen, raloxifene, estrogen or hormonal replacement therapy, alendronate, or vaginal estrogens) that may alter the risk of important medical outcomes (e.g., cancer endpoints or estrogen deficiency disorders) in these participants.
• Monitor overall mortality and the incidence of various disease states that complicate long-term estrogen deficiency (e.g., osteoporosis, skeletal fractures, coronary artery disease, or myocardial infarction) in these participants.
• Monitor these participants' and their health care providers' adherence to recommendations regarding the management of non-oncologic morbidity related to premature menopause.
• Analyze the factors (regarding cancer risk reduction and screening activities) that influence a woman's choice between RRSO vs screening.
• Establish normal ranges and distributions within and between high-risk participants for CA 125 values over time, with sub-classification by pre/postmenopausal status, HRT usage, RRSO status, and other risk factors.

OUTLINE: This is a multicenter study. Participants choose 1 of 2 screening/prevention groups.

• Group I (screening): Participants undergo genetic risk, medical and ovarian cancer risk factor; transvaginal ultrasound (TVUS); and CA 125 measurement. CA 125 is measured every 3 months and the Risk of Ovarian Cancer Algorithm (ROCA) is determined.TVUS is repeated annually (unless ovaries have been removed) as is a mammogram. If screening tests are abnormal, TVUS may be repeated and laparotomy/laparoscopy may be performed if a malignancy is suspected or a benign finding requires surgery.
• Group II (risk-reducing surgery): Participants undergo genetic risk, medical and ovarian cancer risk factor; TVUS; and CA 125 measurement. Participants then undergo risk-reducing salpingo-oophorectomy (RRSO). CA 125 is measured and ROCA calculated every 6 months. A mammogram is performed annually. Abnormal screening results are treated as in group I.

Quality of life is assessed at baseline and at 6, 12, 24, and 60 months for some participants.

Participants in group I who decide to undergo RRSO may cross-over to group II at any time.

PROJECTED ACCRUAL: A total of 2,332 participants will be accrued for this study.