A lthough only about 10% of all epithelial ovarian carcinomas occur as a result of inherited mutations in cancer predisposition genes, primarily BRCA1 and BRCA2, this subset of ovarian carcinomas has been the subject of intense interest and study, with fascinating results. The familial cancer syndromes involved were identified first by clinical epidemiologists in the 1970s and 1980s. With the advent of the molecular era, the BRCA1 and BRCA2 genes were identified in the 1990s, and we now have a relatively clear understanding of many aspects of their contribution to ovarian carcinomas. 1 The frequency of BRCA mutations varies widely according to population: In the general population of the United States, it may be approximately 1 per 1000 population; whereas, in women of eastern European Jewish ancestry, approximately 2% carry 1 of 3 founder mutations in BRCA1 or BRCA2.2,3 The lifetime risk of developing ovarian carcinoma in women who carry BRCA mutations has been estimated over a fairly broad range, with a greater risk for BRCA1 carriers. The factors that affect penetrance, which are likely to be both clinical and molecular, remain unclear to date. Loss of function of both alleles of BRCA1 or BRCA2 is required for the disease phenotype to develop, consistent with the classic model of a tumor suppressor gene. It has been shown that hereditary and sporadic carcinomas have a number of differences at the molecular level, including the fact that BRCA mutations are not found commonly in sporadic carcinomas. Information about the function of the BRCA proteins is developing, and we know that gene mutation may be only one of several pathways to the absence of a functional protein, with promoter hypermethylation and other mechanisms perhaps playing a role. 4 Translational researchers have been interested in the clinical features of BRCA-related ovarian carcinomas. Although, based on what we know about the actions of the BRCA proteins, it seems likely that BRCA mutations would have an impact on tumor biology and clinical behavior, the medical and scientific community has had a healthy skepticism regarding this possibility. After the initial report of an improved prognosis for women with ovarian carcinoma carrying BRCA1 mutations, 5 a number of authors have examined this issue. For the most part, the larger studies with long-term follow-up have confirmed this observation. To date, the most definitive data on this issue come from Boyd et al., 6 who published a large, well-designed, and well-analyzed single-institutional study using multivariate analysis to show that BRCA mutation status was a significant predictor of survival 2127