Women’s cancers: new guideline calls for genetic testing in all advanced ovarian cancer

If you or someone you love is facing ovarian cancer, here is a clear piece of news. A new guideline on women’s cancers says everyone newly diagnosed with advanced ovarian cancer should get genetic testing. The results help decide which treatment fits best, and when.

The guideline also looks at PARP inhibitors, a group of cancer pills. It says they work best when they are used right after the first response to chemotherapy, in the patients most likely to benefit.

How the study worked

This is a “living guideline” from the American Society of Clinical Oncology (ASCO). An expert panel reviewed the research and will keep updating its advice as new studies come in. It was published Oct. 27, 2026, in the Journal of Clinical Oncology. The panel looked at 79 publications, and as with any guideline, doctors still tailor the advice to each patient.

What they found

The panel reviewed 31 key trials of PARP inhibitors. It also looked at 18 studies covering 13 different tests for homologous recombination deficiency, or HRD. HRD means a tumor has trouble repairing its own DNA. That weakness is what PARP inhibitors, such as olaparib, are designed to attack.

Here is what the panel recommends:

• Testing for everyone. All patients with newly diagnosed advanced epithelial ovarian cancer should have genetic testing. If that test is negative for BRCA mutations, the tumor itself should be tested for HRD. The tests should be FDA-approved or carefully validated.
• First remission comes first. After chemotherapy works, a PARP inhibitor pill taken as ongoing “maintenance” should be offered to people with BRCA1/2 mutations or HRD-positive tumors. Olaparib can also be paired with bevacizumab for some of these patients.
• Not for every tumor. PARP inhibitors are not recommended for early-stage disease, or for tumors with no BRCA mutation that are HRD-negative.
• More limited if the cancer returns. Maintenance should mostly go to people with BRCA1/2 mutations who have never taken a PARP inhibitor and who respond to platinum chemotherapy. PARP inhibitors alone should not be used to treat a recurrence outside clinical trials. They also should not be combined with chemotherapy or other newer drugs outside trials.

Why the narrower focus? Trials that used these pills early showed people lived longer without their cancer getting worse. Trials of later use reported that overall survival could actually be worse. So the guideline points the pills to where the benefit is clearest.

Doctors are also asked to watch for rare but serious problems. These include certain blood conditions (myelodysplastic syndrome and acute myeloid leukemia) and lung complications.

What does “genetic testing” mean here?

It usually means a test that looks for inherited changes in genes like BRCA1 and BRCA2. These changes can affect how a cancer behaves and which drugs work against it. The tumor test for HRD is a second step, used when the BRCA result is negative. Together, the two tests give your care team a fuller picture.

This recommendation is for people with a new diagnosis of advanced epithelial ovarian cancer. It is good to know that testing is now the clear standard at that point. The results can also be useful to relatives, who may benefit from genetic counseling.

What you can do today

If you have or had ovarian cancer, take two minutes to write down whether you have had genetic (BRCA) testing and tumor HRD testing. If you are not sure, add both to your list of questions for your next oncology visit. If you are helping a family member, keep the note in the same place as their appointment papers.