A Trial Using Novel Markers to Predict Malignancy in Elevated-Risk Women

Inclusion Criteria:

Risk Group 1, Women ages 25 - 80:

   - The subject has tested positive for a deleterious germ line mutation in BRCA1 or
   BRCA2.

Risk Group 2, Women ages 35 - 80, Pedigree conditions can be satisfied by multiple primary
cancers in the same person:

   - The subject has a personal history of breast cancer diagnosed before or at age 50.

   - OR the subject has a personal history of bilateral breast cancer

   - OR the subject has one first-degree relative with breast cancer diagnosed before or at
   age 50.

   - OR the subject has two breast cancers in the first or second degree relatives, same
   lineage, with at least one breast cancer diagnosed before or at age 50.

   - OR the subject has three or more first or second degree relatives, same lineage, with
   breast cancer diagnosed at any age.

   - OR The family contains at least one ovarian cancer diagnosed at any age in the first
   or second degree relatives.

   - OR the subject is of Ashkenazi ancestry and has had breast cancer diagnosed at any
   age.

   - OR The subject is of Ashkenazi Jewish ethnicity and has one first or second degree
   relative with breast cancer diagnosed at any age (must be in the same lineage as the
   Ashkenazi ancestry)

   - OR The subject has a male relative with breast cancer diagnosed at any age

   - OR The subject has a personal history of a positive genetic test result for a
   deleterious germline mutation in the P53 gene.

   - OR The subject has tested positive for a deleterious germline mutation in one of the
   DNA mismatch repair (MMR) genes associated with the Hereditary Non-Polyposis
   Colorectal Cancer Syndrome (HNPCC, also known as Lynch Syndrome) The MMR genes include
   MLH1, MSH2, MSH6 and PMS2.

   - OR the subject has a first or second degree relative with an identified deleterious
   germline BRCA1 or BRCA2 mutation, but has not yet undergone testing herself.

   - OR the subject has a first or second degree relative with an identified deleterious
   germline MMR gene mutation, but has not yet undergone testing herself.

   - OR Probability of carrying a BRCA1 or BRCA2 mutation given family pedigree of breast
   and ovarian cancers exceeds 20% by any existing BRCA mutational probability model.

Risk Group 3, Women ages 45 - 80:

   - Have measurement of CA125, HE4, MMP7 or Mesothelin exceeding the 95th percentile;

   - OR have a relative risk of at least 2 based on the EpiRisk logistic regression model
   including age, family history, and other risk factors.

Exclusion Criteria:

   - Removal of both ovaries for any reason.

   - History of ovarian, fallopian tube cancer or peritoneal carcinomatosis.

   - Currently pregnant.

   - Unable or unwilling to provide informed consent.

   - Unwilling to provide the name of a physician.

   - Unwilling to sign informed consent and/or medical records release form.

   - Current untreated malignancy (other than non-melanoma skin cancer).

   - Currently receiving adjuvant chemotherapy or radiation therapy for cancer (except
   tamoxifen or aromatase inhibitors +/- lupron). Patients who are being treated may
   enroll 3 months after completion of last treatment.

   - Intraperitoneal surgery within the last 3 months (laparoscopy or laparotomy).

   - A medical condition that would place subject at risk as a result of the blood
   donation, including but not limited to bleeding disorders, chronic infectious disease,
   emphysema or serious anemia.

   - Subject has a family member who is a carrier of a BRCA or MMR gene mutation and the
   subject has undergone genetic testing that included the family mutation and no
   mutation was found, and there are no cases of ovarian cancer in the family.