Scientists develop an algorithm to measure the risk of ovarian cancer, delaying surgical menopause

At 36, Natasha Wray had just completed a gruelling two-year cancer treatment when doctors warned her of another looming threat - a heightened risk of ovarian cancer.

She was faced with a life-changing dilemma - undergo surgery to remove her ovaries and fallopian tubes, eliminating the risk of ovarian cancer, or preserve her fertility and the possibility of having a child.

"I was 36 at the time, and I said absolutely not… I also didn't want to go through a surgical menopause in my mid-thirties," she says.

"I very much wanted to be a mum, so I definitely wanted to hold on to any fertility that I did have".

Unlike breast cancer, there’s no equivalent of a mammogram for ovarian cancer, and for women at high genetic risk, such as those carrying BRCA1 or BRCA2 mutations, preventative surgery remains the most effective proven way to reduce risk, though it leaves women infertile.

Wray was given the opportunity to enter a pilot screening conducted by University College London Hospital.

The blood test is called ROCA, which stands for "risk of ovarian cancer algorithm" and allows doctors to screen for proteins and other cancer-causing substances as well as alterations in genes associated with cancer.

For women like Wray, the test provided crucial reassurance and time to start a family before considering surgery.

Thanks to the ROCA test, Wray was able to delay surgery long enough to have her son.

"I was obviously getting enough reassurance from that test to feel safe,” Wray said.

After she gave birth, her test showed that she had a raised risk.

“I think my son was about three, we were about to go on holiday and I do remember being on holiday thinking, okay, how much longer am I going to leave it".

Women at risk are advised to take the test every four months to monitor any changes.

Doctors who ran the trial say the screening offers "breathing space" to those not yet ready for surgery.

"It's designed really as a damage limitation option for women who are not yet ready to have the surgery because of the potentially devastating effects that surgery can have on them,” said Adam Rosenthal, a consultant gynaecologist at the UCLH.

“It shouldn't be viewed as an alternative to the surgery because they do need to have the tubes and ovaries removed at some point".

For some women, the test helps guide their decision-making.

"It's incredibly individual. Some women will do the testing for a few months; they may have a slightly abnormal result that isn't actually cancer, but it terrifies them, and that's the prompt for them to go and have the surgery,” Rosenthal said.

“Others will carry on with the testing because they just can't face the surgery until they've been through a natural menopause. So you see all extremes and everything in between," he added.

Now, after a successful trial, the test is being made available to women at high risk of ovarian cancer in the UK through the National Health Service (NHS), but previously it was only available privately.

Thousands of women in the UK who have particular genes that put them at a high risk of ovarian cancer have access to the test.

Europe recorded the highest rates of ovarian cancer incidence and mortality worldwide in 2020, according to the World Health Organisation (WHO) International Agency for Research on Cancer. In the same year, approximately 68,000 new cases were reported, according to the European Commission.

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