Our objective was to identify demographic, medical, and psychological correlates of ovarian cancer screening utilization in a sample of women at increased risk. We designed a cross-sectional study that evaluated demographic factors, risk factors, psychological factors, and utilization of ovarian cancer screening in first-degree relatives of ovarian cancer patients. In multivariable analysis, use of CA-125 was associated with number of affected relatives [odds ratio (OR), 2.9; 95% confidence interval (95% CI), 1.3-6.5] and ovarian cancer worries (OR, 2.9; 95% CI, 1.1-8.1). For ultrasound (transvaginal or abdominal), the model included employment status (OR, 2.7; 95% CI, 1.1-6.8) and ovarian cancer worries (OR, 3.3; 95% CI, 1.2-9.1). Significant interaction terms in the ultrasound models indicated that employment was a significant predictor of ultrasound utilization in women with 2 or more affected relatives. Among women with only one affected relative, ultrasound use was strongly associated with the presence of ovarian cancer worries. Utilization of ovarian cancer screening among women at increased risk is influenced by psychological and sociodemographic factors, in addition to level of risk.