A patient with ovarian cysts who has a positive family history of BRCA mutations presents with a functional cyst. Which factor would most strongly suggest considering surgical evaluation?

A patient with ovarian cysts who has a positive family history of BRCA mutations presents with a functional cyst. Which factor would most strongly suggest considering surgical evaluation?

• A. Age 22
• B. Small cyst less than 2 cm
• C. Positive family history of BRCA mutation
• D. Normal CA-125 level

Answer: (C)

The key idea is hereditary cancer risk driving management. In premenopausal women, many ovarian cysts are benign functional cysts and can be watched with follow-up. But a positive family history of BRCA mutations signals a much higher risk of epithelial ovarian cancer. BRCA mutation carriers have a significantly increased lifetime risk, and cancers can arise even when an ovarian lesion appears benign or functional. CA-125 can be normal in early or premenopausal disease, so a normal level does not rule out cancer in this context. An individual with BRCA-related risk thus warrants stronger consideration of surgical evaluation to exclude malignancy and to guide definitive management, even if the cyst seems functional. Hence, the familial BRCA history is the factor that most strongly suggests surgical evaluation.

The key idea is hereditary cancer risk driving management. In premenopausal women, many ovarian cysts are benign functional cysts and can be watched with follow-up. But a positive family history of BRCA mutations signals a much higher risk of epithelial ovarian cancer. BRCA mutation carriers have a significantly increased lifetime risk, and cancers can arise even when an ovarian lesion appears benign or functional. CA-125 can be normal in early or premenopausal disease, so a normal level does not rule out cancer in this context. An individual with BRCA-related risk thus warrants stronger consideration of surgical evaluation to exclude malignancy and to guide definitive management, even if the cyst seems functional. Hence, the familial BRCA history is the factor that most strongly suggests surgical evaluation.