**14. Challenges in development of universal process on screening genetic mutations in ovarian cancers**

In Our Opinion, all the patients diagnosed with invasive, epithelial ovarian cancer should be offered germline genetic testing, regardless of histologic subtype, because Ovarian cancers with a *BRCA1/BRCA2* mutation are most likely to be of high-grade serous histology, although these mutations have been found in endometrioid and clear cell histologic subtypes as well. Endometrioid and clear cell ovarian cancers are also frequently associated with Lynch syndrome (germline mutations in *MLH1*, *MSH2*, *MSH6*, *PMS2*, and *EPCAM*). Additionally, nonepithelial ovarian cancers - Sertoli-Leydig cell tumours can be associated with other genetic disorders such as Peutz-Jeghers syndrome and DICER1-associated disorders and small cell carcinoma of the ovary, hypercalcaemic type has been linked to germline mutations in *SMARCA4*.

All these mutations have got clinical relevance in the management of these patients and yet to discover the treatment options and preventing the development of the other cancer types associated with the above syndromes in the future generations with genetic predisposition.

There are several identified limitations in screening these mutations including cost of testing, lack of patient and provider education regarding the importance of genetic information, and limited availability of genetic counsellors and access to genetic testing [26].

In the era of unforeseen issues with Covid-19 there are other issues with genetic testing including social distancing making the genetic counselling, consenting difficult necessitating these steps to be delivered audio-visually.
