Ovarian cancer is the most lethal gynaecological malignancy, with 314,000 new cases and 207,000 deaths annually worldwide. It is predicted to increase by 42% and 55% in Australia by 2040. Despite advances in treatment, ovarian cancer remains lethal, with 80% of cases diagnosed at advanced stages (III and IV), leading to 27% and 13% five-year survival rates, respectively. Screening for ovarian cancer in women at average risk has not shown mortality benefits in large randomized trials, so it is not currently recommended. However, more frequent surveillance in high-risk women has shown good performance characteristics and significant downstaging, though no survival benefit has been demonstrated. For high-risk women, screening has not been recommended, and there is no national surveillance program in Australia. However, risk-reducing salpingo-oophorectomy (RRSO) is recommended for women with a 4–5% lifetime risk of ovarian cancer. Pre-menopausal women without contraindications to hormone replacement therapy (HRT) should be offered HRT until 51 years of age to minimize the effects of premature menopause. RRESDO and OBS are being explored as alternatives for high and average risk women, respectively. Novel biomarkers and screening strategies are being investigated globally, including DNA methylation, cell-free DNA, and circulating tumour DNA. These may offer improved early detection. However, the accuracy of these biomarkers for early-stage ovarian cancer remains limited. The role of the fallopian tube in ovarian cancer etiology is increasingly recognized, leading to advances in preventive strategies such as RRSO, RRESDO, and OBS. Improved identification of women at increased risk through genetic testing and population-based screening is essential. Unselected genetic testing at cancer diagnosis can identify individuals who may benefit from secondary cancer prevention. Population-based testing has shown cost-effectiveness in several countries. The use of sophisticated risk models incorporating polygenic risk scores, family history, and other factors is helping to personalize risk assessment. Surgical prevention remains the most effective strategy for ovarian cancer prevention. RRSO is recommended for BRCA1/2 carriers and those with Lynch syndrome. It reduces ovarian cancer risk by 80–97% in BRCA carriers and is cost-effective. However, it is associated with early surgical menopause, which can have negative health effects. HRT is recommended for pre-menopausal women to mitigate these effects. Risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) is being evaluated in research trials and is associated with fewer menopausal symptoms and better sexual function compared to RRSO. OBS is increasingly used in routine gynaecological surgery and has shown a reduction in ovarian cancer risk. Overall, while ovarian cancer screening for averageOvarian cancer is the most lethal gynaecological malignancy, with 314,000 new cases and 207,000 deaths annually worldwide. It is predicted to increase by 42% and 55% in Australia by 2040. Despite advances in treatment, ovarian cancer remains lethal, with 80% of cases diagnosed at advanced stages (III and IV), leading to 27% and 13% five-year survival rates, respectively. Screening for ovarian cancer in women at average risk has not shown mortality benefits in large randomized trials, so it is not currently recommended. However, more frequent surveillance in high-risk women has shown good performance characteristics and significant downstaging, though no survival benefit has been demonstrated. For high-risk women, screening has not been recommended, and there is no national surveillance program in Australia. However, risk-reducing salpingo-oophorectomy (RRSO) is recommended for women with a 4–5% lifetime risk of ovarian cancer. Pre-menopausal women without contraindications to hormone replacement therapy (HRT) should be offered HRT until 51 years of age to minimize the effects of premature menopause. RRESDO and OBS are being explored as alternatives for high and average risk women, respectively. Novel biomarkers and screening strategies are being investigated globally, including DNA methylation, cell-free DNA, and circulating tumour DNA. These may offer improved early detection. However, the accuracy of these biomarkers for early-stage ovarian cancer remains limited. The role of the fallopian tube in ovarian cancer etiology is increasingly recognized, leading to advances in preventive strategies such as RRSO, RRESDO, and OBS. Improved identification of women at increased risk through genetic testing and population-based screening is essential. Unselected genetic testing at cancer diagnosis can identify individuals who may benefit from secondary cancer prevention. Population-based testing has shown cost-effectiveness in several countries. The use of sophisticated risk models incorporating polygenic risk scores, family history, and other factors is helping to personalize risk assessment. Surgical prevention remains the most effective strategy for ovarian cancer prevention. RRSO is recommended for BRCA1/2 carriers and those with Lynch syndrome. It reduces ovarian cancer risk by 80–97% in BRCA carriers and is cost-effective. However, it is associated with early surgical menopause, which can have negative health effects. HRT is recommended for pre-menopausal women to mitigate these effects. Risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) is being evaluated in research trials and is associated with fewer menopausal symptoms and better sexual function compared to RRSO. OBS is increasingly used in routine gynaecological surgery and has shown a reduction in ovarian cancer risk. Overall, while ovarian cancer screening for average