A 67-year-old woman presents with complaints of persistent indigestion, abdominal discomfort, bloating, and early satiety. Over the past four weeks, she has experienced a 10-pound weight loss and worsening pelvic pressure. Her medical history is notable for long-term hormone replacement therapy (HRT) to manage menopausal symptoms. She had menarche at age 10 and reached menopause at age 54. She has one child, born when she was 32. Her family history is significant: her mother died of breast cancer associated with a BRCA1 mutation, and her older sister succumbed to ovarian cancer linked to a RAD51C mutation. Additionally, she smokes about 6 cigarettes a day and is of Ashkenazi Jewish descent. On examination, a palpable abdominal mass and ascites are noted, and CT imaging reveals a complex adnexal mass with ascitic fluid and umbilical nodularity. Question: Which of the following factors in her history increase her risk for ovarian cancer?
