What is BRCA? How is it related to breast and ovarian cancer? In 1990, researchers identified a gene closely related to hereditary breast cancer, named breast cancer gene 1 (BRCA1), localized on chromosome 17; four years later, researchers identified another gene related to breast cancer on chromosome 13, called BRCA2, and the two genes are usually discussed together under the collective name BRCA1/2. BRCA is an oncogene that plays an important role in regulating cell replication, DNA damage repair, and normal cell growth; if the BRCA gene is mutated, it loses its function in suppressing tumorigenesis. there are hundreds of BRCA mutation types, which are associated with the development of many cancers in the human body, the most closely related being breast cancer, followed by ovarian cancer (Figure). here we briefly discuss BRCA Here we briefly discuss the relationship between BRCA mutations and ovarian cancer. Ovarian cancer remains the most serious challenge for gynecologic oncologists because there is no mature method for early diagnosis, and about 70% of patients are in advanced stage when diagnosed, and even after effective treatment to achieve complete remission, 70% of patients will recur, and the 5-year survival rate has been hovering around 30-40%. Therefore, attempts have been made to establish tertiary prevention and control measures for ovarian cancer, just like other chronic diseases. The prevention and control aspects of ovarian cancer include etiological prevention, preclinical prevention, and clinical control. It is generally believed that the following factors can increase the risk of ovarian cancer, including age, family history, failure to give birth, and talcum powder, while oral contraceptives for multiple births, tubal ligation, breastfeeding, hysterectomy, can reduce the risk of ovarian cancer. Among them, family history is the most important risk factor. It is generally accepted that if a woman has no ovarian cancer in her family, her lifetime chance of developing ovarian cancer is about 1.4% (1/70), and if there are 2 or more first-degree relatives with the disease, the chance of developing ovarian cancer rises further to 7%, and if it is determined to be a family with BRCA1/2-related hereditary ovarian cancer, the chance of developing ovarian cancer increases to 40%-50%! Highlighting the importance of BRCA gene mutations. Diseases caused by mutations in the BRCA1/2 gene are autosomal dominant, and cancer can occur with the deletion or abnormal function of a gene in a normal copy of one chromosome in a single cell. Fortunately, not all carriers will inevitably develop cancer, but only have a high susceptibility to cancer, the so-called “variable epistasis”. It is estimated that of the more than 300 million Americans, approximately 250,000-500,000 are carriers of the BRCA1/2 gene mutation. The BRCA mutation carriage rate in the general population is 1/400-600, while in some specific ethnic groups it is as high as 1/40-50, e.g. German Jews, and the BRCA1/2 mutation carriage status in the Chinese population is unknown and is generally considered to be lower than in the United States and the Nordic countries. Of the genes currently known to be associated with hereditary breast/ovarian cancer, BRCA1 mutations contribute 20-30%, BRCA2 mutations 10%-30%, and less than 1% of other types of mutations, respectively, suggesting that testing for BRCA mutations in certain specific populations is necessary. These populations include those with multiple patients who developed breast cancer at a young age in their family; a family history of breast or ovarian cancer; breast and ovarian cancer in the same woman; bilateral breast cancer; people of German-Jewish descent; and male breast cancer. Currently the most reliable test for BRCA mutations is whole genome DNA sequencing, which detects 90% of the mutated loci and costs about $3000. Other simple and inexpensive methods are available, but are limited in the number of mutated loci they can detect. It is important to note that a positive test result is of greater value, but a negative test result does not guarantee that the person tested is safe and sound, as mutations at some loci are not yet detectable. How can interventions be taken to prevent the development of ovarian cancer using BRCA test results (especially positive results)? It has been shown that prophylactic removal of the ovaries and fallopian tubes significantly reduces the risk of ovarian and breast cancer, but also increases the risk of coronary heart disease, osteoporosis and stroke. Therefore, prophylactic removal of ovaries and fallopian tubes to prevent ovarian cancer is not advocated for women who do not have risk factors for ovarian cancer. However, for women with BRCA1/2 gene mutation, prophylactic tubal and ovarian resection is recommended. When should prophylactic ovarian and tubal resection be performed? Data show that the median age of sporadic ovarian cancer is 63 years, whereas ovarian cancer occurs at a younger age in BRCA mutation carriers, with 17% occurring before the age of 40 and 33% before the age of 50. Therefore, the optimal timing of surgery is currently considered to be before the age of 40, or a few years later, after completion of reproductive tasks. Interestingly, histopathological studies suggest that high-grade ovarian epithelial carcinoma does not originate from the ovary itself, but from the distal fallopian tube. This view is also supported by clinical data, with studies showing that the risk of ovarian cancer decreases by more than 60% in women who have their fallopian tubes removed! Therefore, in BRCA1/2 mutation carriers, removing only both fallopian tubes without removing the ovaries can also go a long way in preventing ovarian cancer.