1. Other Risk Reduction Strategies Patients who do not wish to undergo RRSO can avoid the risk by taking combined oral contraceptives (COCs). In a case-control study of 670 women with BRCA1 mutations and 128 women with BRCA2 mutations, it was shown that the use of COCs reduced the risk of ovarian cancer in BRCA1 mutation carriers (OR=0.56) and BRCA2 mutation carriers (OR=0.39). Similar results were reported by Cibula et al. who conducted a meta-analysis of three case-control studies and showed that BRCA1 and BRCA2 mutation carriers who had taken COC in the past had a significantly lower risk of ovarian cancer, positively correlated with the duration of administration. For women with BRCA gene mutations, there are other options such as CA-125 testing and transvaginal ultrasound; however, this method does not detect tumors in the early curable stages, so it is not recommended. Tamoxifen is said to reduce the risk of cancer in the contralateral breast by up to 53% in breast cancer patients with the mutation, but there is no data in the literature to suggest that tamoxifen reduces the incidence of ovarian cancer. In 2007, Crumet et al. stated that a type of highly differentiated plasma ovarian cancer originated in the distal fallopian tubes, thus coining the term tubal intraepithelial neoplasia (TIC). The etiology of TIC in pelvic plasmacytoid carcinoma is unknown. The definition of this term is important because it may provide an additional approach to surgery to reduce the risk of developing pelvic plasma cancers, which is especially important for women with BRCA gene mutations. In fact, it has been suggested that the fallopian tubes be routinely removed at the time of hysterectomy at the completion of labor, even for benign lesions. This approach should not be recommended for routine use until there is a sufficiently large body of data to suggest feasibility. Lynch syndrome Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), is caused by DNA mismatch repair genes (MLH1, MSH2, PMS2, or MSH6).Patients with HNPCC have an approximate risk of developing endometrial and ovarian cancers of 42-60% and 9-12%, respectively, by the age of 70 years.Female patients with HNPCC have a lifetime risk of developing about female patients with HNPCC have a lifetime risk of colorectal cancer of approximately 40%-60%. Genetic risk analysis for these hereditary cancer syndromes enables clinicians to provide individualized, quantitative risk assessments, as well as specific screening and prevention strategies to reduce the incidence of these inherited conditions (e.g., Box 3). Strategies such as colonoscopy and risk-reducing surgery can improve outcomes for individuals at genetic risk. Hysterectomy with bilateral salpingo-oophorectomy and salpingo-oophorectomy should be considered for individuals at high risk of ovarian cancer because Lynch syndrome has been shown to be associated with a risk of endometrial and ovarian cancer, and it is strongly recommended that such surgery be performed at the time of delivery in this high-risk group. Genetic risk analysis is recommended for patients with a genetic predisposition to endometrial cancer, colorectal cancer, or related tumors greater than 20%-25%: Patients with endometrial or colorectal cancer who meet the revised Amsterdam criteria, which are as follows: (1) At least 3 relatives with Lynch/HNPCC-related cancers in 1 lineage (colorectal, endometrial, small bowel, ureteral, or renal pelvic cancer). (2) 1 of these individuals must be 2 other first-degree relatives (3) Must be cumulatively 2 consecutive generations (4) At least 1 individual with colorectal cancer onset earlier than age 50 years Patients with concurrent or heterochronous diagnosis of endometrial or colorectal cancer with the first tumor diagnosed before age 50 years. Patients with concurrent or heterochronous diagnosis of ovarian or colorectal cancer and the first tumor was diagnosed before age 50. Patients with colorectal or endometrial cancer with evidence that evidence of a mismatch repair gene exists (e.g., MSI or MLH1, MSH2, MSH6, or PMS2 expression immunohistochemically indicated to be absent) Patients with first- or second-degree relatives who have a known mismatch repair gene Box 3 Guidelines for Recommendations for Counseling and Testing of Lynch Syndrome (HNPCC) Guidelines for Routine Testing and Counseling Risk of developing hereditary tumors Evaluation should: include risk assessment, education, and counseling; be performed by a physician, genetic counselor, or other provider with a background in cancer genetics; and genetic analysis after reasonable counseling and obtaining consent. Informed consent is required to perform a genetic analysis of cancer predisposition, which should include pre-test education, risks associated with testing, benefits and limitations, and significance of positive and negative results. The pre-test conversation should also include information about the limitations of current genetic analysis techniques, the risk of false-negative results, and the uncertainty of unknown genetic variants of clinical significance. Individuals considering genetic analysis should be aware of the potential for psychological stress and family implications of such testing. Such risks also have the potential to discriminate in health insurance and employment, but have not occurred to date. Other factors should also be considered when counseling women about the management of menopausal symptoms and hormone replacement therapy (HRT). Surgically induced menopause is more significantly vasodilated than natural menopause. Hormone replacement therapy is effective in the management of surgically induced menopausal symptoms. In addition, patients with BRCA gene mutations who had undergone RRSO before the age of 50 and were treated with HRT did not have an increased risk of breast cancer, which is a result of comparison with similar women who were not treated with HRT. Women with a history of ER-positive breast cancer due to a BRCA gene mutation do not need to undergo HRT after RRSO. primary peritoneal carcinomas may still occur in women who have undergone risk-reducing surgery. Other genetic mutations that may affect cancers of the female reproductive tract: Black spot polyp syndrome (PeutzCJeghers syndrome), a group of disorders characterized by chromochromic lesions of the lip/buccal mucosa and multiple polyps of the gastrointestinal tract that arise due to mutations in the STK11 gene. Cowden syndrome, due to mutations in the PTEN gene, is a group of disorders characterized by multiple misshapen tumors, distinctive cutaneous pathology, and a predisposition to the development of various malignant tumors (especially endometrial cancer). Li-Fraumeni syndrome (LiCFraumeni syndrome) is a disease characterized by multiple primary tumors, mainly soft tissue sarcomas. The syndrome is associated with germline mutations in the TP53 oncogene and increases the risk of breast cancer. Summary of key points 1. Tumors are a group of inherited diseases with germline mutations or somatic mutations. 2, BRCA1, BRCA2 gene mutations and mismatch repair genes (Lynch syndrome) can be detected in genetic testing. 3. Genetic counseling is extremely important for suspected patients with genetic risk and should be recommended before genetic analysis. 4. Once a genetic mutation is detected, patients should be informed about risk-reducing procedures, other risk-reduction strategies and changes in screening. 5. Hereditary cancer risk may affect other family members, and genetic analysis should be recommended for high-risk groups in the family.