Ovarian cancer screening is not indicated for this patient. The lifetime risk of developing ovarian cancer is 1.4%, and this patient is of average risk. She does not have a family history suggestive of a hereditary ovarian cancer syndrome, such as family members with ovarian cancer; premenopausal breast cancer; bilateral breast cancer; the presence of both ovarian and breast cancer on the same side of the family; or the presence of Lynch syndrome cancers such as colon, endometrial, or gastric cancers. She is multiparous, has no symptoms suggestive of ovarian cancer, and has a normal pelvic examination. In addition, she used oral contraceptives for 15 years, which lowers the risk of ovarian cancer by 50%, with the protective effect lasting 30 years.

Neither serum CA-125 testing nor transvaginal ultrasound is indicated for asymptomatic women at average risk for ovarian cancer. Serum CA-125 levels are elevated in approximately 50% of women with early-stage ovarian cancer and in 80% of those with advanced ovarian cancer, but this finding is not very specific. Levels are also elevated in approximately 1% of healthy women and fluctuate during the menstrual cycle. Elevated serum CA-125 values also occur in several benign conditions, such as endometriosis, uterine fibroids, hepatitis, and peritonitis, as well as in endometrial, breast, lung, and pancreatic cancers.

The largest randomized controlled trial evaluating ovarian cancer screening in women at average risk was the Prostate, Lung, Colon, and Ovarian (PLCO) Cancer Screening Trial, in which 78,216 women were assigned to either usual care or annual serum CA-125 testing for 6 years plus annual transvaginal ultrasound for the first 4 years. After a median follow-up of 12 years, ovarian cancer was diagnosed in 5.7% of women in the screening group and 4.7% of women in the usual care group, but there was no difference between the two groups in the number of deaths due to ovarian cancer. In addition, 3285 women had false-positive results, 1080 of whom underwent surgery; 163 of the women who underwent surgery experienced at least one serious complication (15% of surgical procedures).

Patients who have a high risk of ovarian cancer, such as women with BRCA1/2 mutations, are recommended to have semi-annual screening with pelvic examinations, serum CA-125 testing, and transvaginal ultrasound beginning at age 30 years. However, even in this high-risk group, there is no evidence that screening decreases ovarian cancer mortality. For these women, prophylactic bilateral salpingo-oophorectomy once childbearing is completed, ideally by age 35 to 40 years, is recommended.