Gynecologic Oncology and Family History of Breast, Ovarian, and Endometrial Cancer

Gynecological cancers, such as breast, ovarian, and endometrial cancers, are among the most common types of cancer in women—and it is not uncommon for them to run in families. The question of a possible genetic predisposition therefore plays a central role, both in assessing individual risk and in early prevention.

Modern gynecologic oncology today combines precise diagnostics, personalized treatment approaches, and sensitive counseling regarding family risks. It is precisely at this intersection of medicine, genetics, and personal life planning that the importance of comprehensive, understandable, and forward-looking care for affected women and their families becomes evident.

To discuss this topic, the editorial team of the Leading Medicine Guide spoke with Paul Gaß, Priv.-Doz. Dr. med. habil., a specialist in gynecology and obstetrics.

For patients with a family history of cancer, an increased risk of breast, ovarian, or endometrial cancer can now be assessed in great detail by combining a precise medical history with modern genetic diagnostics and close monitoring for early detection. 

“It all starts with a thorough family medical history. Using checklists from the German Cancer Society (DKG), we systematically assess whether the criteria for genetic testing are met. But heredity isn’t the only factor: Certain tumor biology characteristics make germline testing—a genetic test—absolutely essential.

This test determines whether a person carries inheritable mutations in their germline cells that can increase the risk of certain diseases, particularly cancer. For ovarian cancer, this applies to patients up to age 80; for breast cancer, a triple-negative (TNBC) tumor biology is a decisive factor up to age 70, even if no cases have occurred in the family to date. Diagnostics follow the standards of the German Consortium for Familial Breast and Ovarian Cancer.

Testing is initiated through our two certified centers (Breast Center and Gynecologic Cancer Center) and conducted in specialized laboratories at the university hospitals in Leipzig or Dresden. “We then discuss the results in person during our consultation hours for familial breast and ovarian cancer (FBREK), which have been in place since March 2026,” explains PD Dr. Gaß at the beginning of our conversation. 

Genetic testing methods such as BRCA analyses or tests for Lynch syndrome play a central role in accurately assessing an individual’s risk of breast, ovarian, or endometrial cancer. Not only do they enable a significantly more accurate risk assessment, but they also give patients the opportunity to tailor their preventive care and treatment plans on a well-founded, personalized basis.

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A BRCA analysis is a genetic test that checks whether the BRCA1 and BRCA2 genes—named after BReast CAncer—contain hereditary mutations that significantly increase the risk of breast and ovarian cancer.

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PD Dr. Gaß explains: “If the patient meets the established criteria, genetic testing is covered by health insurance. The test specifically analyzes genes that increase the risk of breast, ovarian, or endometrial cancer. If a genetic predisposition is identified, the type of counseling provided is crucial. The Genetic Diagnostics Act requires that counseling be conducted by specially qualified physicians. The counseling is strictly non-directive—meaning the patient does not receive instructions, but rather a well-founded basis for making a decision.

Together with specialists in human genetics, we interpret the test results, paying particular attention to the difference between relative and absolute risks in order to alleviate fears and enable a realistic assessment of the situation. On this basis, we discuss individualized prevention strategies: These range from intensified early detection to identify tumors as early as possible to prophylactic surgeries.

The goal is to find a tailored solution for each patient that balances close monitoring with risk-reducing interventions.” 

A proven family history of breast, ovarian, or endometrial cancer fundamentally changes treatment planning because it not only statistically increases the risk but also makes it medically tangible. For many patients, this means that prevention, early detection, and treatment are no longer based on general standards, but rather on an individually tailored approach that combines genetic findings, personal circumstances, and medical priorities.

“Whether prophylactic surgery is recommended depends on the specific gene mutation, age, and the overall risk profile. Not every genetic mutation examined automatically leads to a recommendation for preventive surgery—even with a lifetime penetrance of up to 80 percent, the decision remains an individual one. For example, a 79-year-old patient with ovarian cancer would benefit very little from a preventive mastectomy.

The situation is different for a young woman with a high-risk mutation: In this case, we must discuss issues related to reconstruction, family planning, and the alternative of intensified early detection. Such procedures always have psychological, cosmetic, and emotional dimensions as well. “Our goal is to balance tumor biology and age with the patient’s personal wishes,” says PD Dr. Gaß, adding: 

“That’s why the first consultation is never about clarifying every detail right away. Too much information would overwhelm the patient and her family. Instead, we establish an initial framework: What options are available? What risks are involved? What options would be theoretically feasible? Many patients then seek support in self-help groups such as the BRCA Network or speak with their gynecologists.

If they then decide specifically to undergo prophylactic surgery, a second, very detailed consultation follows, during which the surgical options and the exact procedure are discussed.” 

For some patients, preventive surgery may also be an option—a far-reaching step that is therefore taken only after intensive counseling and a careful risk-benefit assessment. In cases of BRCA mutations, preventive removal of the ovaries and fallopian tubes can drastically reduce the risk of ovarian cancer; in cases of very high breast cancer risk, a prophylactic mastectomy may be considered.

In the case of Lynch syndrome, on the other hand, prophylactic removal of the uterus and ovaries may be appropriate once a patient has completed her family planning. Such procedures are never routine but rather reflect a highly individualized strategy that combines medical evidence with personal life decisions. 

It is essential that patients are not left to navigate this process alone. Every therapeutic decision—whether close monitoring, drug-based prevention, or prophylactic surgery—is discussed within an interdisciplinary framework that includes, among others, gynecologic oncology, radiation oncology, genetics, social services, and psycho-oncology. This results in a treatment plan that is not only medically sound but also emotionally sustainable. 

Patients with a family history of the disease often face a dual challenge: they must process medical information that is complex and far-reaching, while simultaneously coping with fears deeply rooted in their own life stories and family experiences. To truly support them, therefore, communication is needed that combines professional precision with genuine human compassion. 

“Take Lynch syndrome (a hereditary tumor predisposition syndrome): Here, the risk of uterine cancer increases significantly, especially after age 50. Therefore, the guidelines recommend prophylactic surgery only after this age.

A 30-year-old patient can thus first take her time to complete her family planning and have the procedure performed later, for example, as she approaches menopause. However, it is important to note that for endometrial and ovarian cancer, there are neither pharmacological measures to reduce risk nor a structured early detection program. Even for the high-risk group, gynecological guidelines do not call for more intensive screening—which clearly distinguishes these types of cancer from breast cancer,” explains PD Dr. Gaß. 

In general, cancer screening in Germany is clearly regulated: Starting at age 20, women are entitled to statutory cancer screening. This includes cervical screening, followed by the HPV test starting at age 35, as well as clinical breast examinations and instruction on how to perform self-exams.

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“The latter is particularly important, because a significant proportion of breast cancer cases are detected by the women themselves through self-examination. Those who know how their own breasts normally feel notice changes earlier. This awareness of one’s own body is a central component of preventive care. In addition, there are general gynecological examinations as well as colorectal cancer screening, which is also stipulated in the statutory guidelines. Alongside all these medical measures, prevention plays a major role—and this is precisely where Germany has some catching up to do.

Many doctors report that prevention is given too little attention in everyday practice, even though it could prevent diseases in the long term and reduce costs. A comparison with other European countries shows that while Germany does not rank worst in terms of smoking rates, it is well above average when it comes to obesity and alcohol consumption. Alcohol is a risk factor for nearly all types of cancer, yet it is hardly regulated in this country and is freely available at all times. Obesity is also a growing problem that is associated with numerous comorbidities and even complicates surgical procedures.

“All these factors are part of preventive care—not just the screenings, but also a conscious approach to lifestyle risks,” notes PD Dr. Gaß. 

For women with an increased familial risk, interdisciplinary collaboration is far more than just an organizational structure—it is the core of truly comprehensive, safe, and proactive care. Precisely because genetic predispositions are medically complex, emotionally taxing, and often involve far-reaching decisions, a team is needed that brings together different perspectives and shares responsibility.

“In genetic testing, several disciplines work closely together. In addition to gynecology, human genetics and laboratory medicine are particularly involved. The actual analysis of the genes takes place in the laboratory and is performed by biologists or biomedical scientists. The human geneticist does not work in the laboratory but evaluates the results, interprets them in a medical context, and conducts the legally required counseling sessions.

This counseling may only be provided by appropriately qualified physicians. In practice, the process begins with the patient describing her family history. Based on this, a family tree is created that maps the affected family members, their diseases, and the respective tumor types. This often leads to ambiguities, such as when patients confuse cervical cancer with endometrial cancer.

Such inaccuracies are accepted and clarified as the process continues, since cervical cancer, for example, has no genetic relevance whatsoever, whereas endometrial cancer does play a role in the context of certain syndromes. The testing itself usually takes about four weeks, including shipping the samples to specialized laboratories. During this time and afterward, emotional support plays an important role.

Many patients arrive with fears, but in most cases, the situation can be managed through experienced, well-structured counseling. “It is only rarely that there is an actual need to initiate psychological support,” states PD Dr. Gaß. 

Currently, about one hundred patients per year undergo genetic testing at Chemnitz University Hospital—with a clear upward trend.

 

PD Dr. Gaß comments: “Southwest Saxony lacks its own center for hereditary breast and ovarian cancer (FBREK Center), such as those in Leipzig and Dresden. However, these two locations are each about a hundred kilometers away, and many people from southwestern Saxony—especially from the Ore Mountains—do not always make the trip. That is why we need regional clinics that have the expertise to initiate testing and provide counseling, even if the actual laboratory analysis continues to be performed centrally at the universities.

The equipment is expensive, and the procedures are complex—centralization makes sense, but access must remain regional. That is precisely why it is important to raise awareness. “For patients, this means shorter travel distances, reliable care, and, at the same time, the assurance that the quality of diagnostics meets the high standards of university centers,” explains PD Dr. Gaß. 

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Counseling on familial predisposition belongs in breast and genital cancer centers, because that is where the relevant cancers are treated and where the necessary expertise is available. And that is precisely where awareness is highest regarding the consistent consideration and initiation of genetic testing. The certification requirements for breast and genital cancer centers now stipulate that 95 percent of all female cancer patients should undergo screening for hereditary cancers.

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Thank you very much, PD Dr. Gaß, for this informative explanation! 

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• Chief Physician at the Department of Gynecology at Chemnitz University Hospital since 2025; many years of experience at Erlangen University Hospital.
• A recognized specialist in gynecologic oncology, particularly breast cancer, gynecologic tumors, and genital dysplasias.
• He leads a modern, interdisciplinary center for women’s health—
• ranging from preventive care to treatment and obstetrics.
• Wide range of surgical and diagnostic services, including care for high-risk pregnancies.
• Advocates for evidence-based medicine, high professional standards, and innovative care models.
• A dedicated university professor who actively promotes the training of the next generation of gynecologists.