Ovarian cancer is the leading cause of death from gynaecological malignancies in the UK. Despite massive funding in developing drugs and new treatment strategies, survival rates remain poor with 10 year survival at ~30%. This corresponds to 4,271 deaths/year in the UK, 42,700 deaths/year in Europe and 152,000 deaths/year worldwide. Familial cancers are responsible for ~10% of ovarian cancers and mutations in the BRCA1/BRCA2 genes account for most of the known hereditary risk. BRCA1/BRCA2 carriers have ~65-72% and ~17-44% risk of developing breast and ovarian cancer, respectively. Screening is not currently available or recommended outside the context of a clinical trial. Primary surgical prevention remains the most proven effective method for reducing population incidence of ovarian cancer. Risk reducing salpingo-oophorectomy (RRSO) is the gold standard for ovarian cancer risk reduction in those at increased (high and intermediate) risk. Traditionally, women at ≥10% life time risk were considered to be high risk and offered options of risk management and surgical prevention. We recently defined the threshold for surgical prevention to be ≥5% life time risk of ovarian cancer, thus showing clinical utility and enabling intermediate risk women to access surgical prevention. This includes those with recently identified moderate penetrance genetic mutations (ovarian cancer risks 5-11%) such as RAD51C, RAD51D and BRIP1, and mutation negative women with a strong family history of ovarian cancer.