Ovarian cancer is the fifth leading cause of cancer death among women in the United States and has the highest mortality rate of all gynecologic cancers. It is estimated that 21,990 new cases of ovarian cancer will be diagnosed in the United States in 2011, and 15,460 women will die of this disease. The median age at diagnosis is 63 years. The prognosis for survival from ovarian cancer largely depends on the extent of disease at diagnosis. The overall 5-year survival rate for ovarian cancer is lower than 50%. Fewer than one-fourth of women present with localized disease at diagnosis.
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Incidence and Mortality
Estimated new cases and deaths from ovarian cancer in the United States in 2011:
New cases: 21,990.
Incidence has been decreasing by 1% per year since 1992, and mortality rates decreased by 1.7% per year since 2002.
Ovarian cancer is rare; the lifetime risk of being diagnosed with ovarian cancer is 1.39%.
Factors Associated With Ovarian Cancer
Several hypotheses have proposed the underlying mechanisms leading to ovarian cancer. Proposed mechanisms include incessant ovulation, hormonal factors such as androgen or gonadotropins, or inflammation. Risk factors support several of these hypotheses, suggesting several possible pathways to ovarian cancer.
Multiparity, oral contraceptive use, and breastfeeding are associated with a decreased risk of ovarian cancer. Oophorectomy reduces but does not eliminate the risk of ovarian cancer because primary peritoneal carcinomatosis may occur.[6,7,8] A history of tubal ligation or hysterectomy with ovarian conservation is also associated with a decreased risk of ovarian cancer.
Risk is increased in women with a family history of ovarian cancer,[5,10,11] with the postmenopausal use of hormone therapy,[12,13] and among women who have used fertility drugs.[5,14] Obesity, tall height, and high body mass index have also been associated with increased risk of ovarian cancer.[15,16,17]
Age at menarche, age at menopause, or age at first live birth is unrelated to the risk of ovarian cancer. Other factors such as perineal exposure to talcum powder have been investigated as possible risk factors for ovarian cancer, but results are conflicting.[18,19]
Several inherited cancer syndromes are associated with an increased risk of ovarian cancer. Families with a history of both ovarian cancer and early-onset breast cancer are suggestive of inherited BRCA1 or BRCA2 gene mutations. (Refer to the PDQ summary on Genetics of Breast and Ovarian Cancer for more information.) An increased risk of ovarian cancer is also associated with hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome. (Refer to the PDQ summary on Genetics of Colorectal Cancer for more information.) Ovarian-only inherited cancer syndromes have also been described, but the gene or genes involved have not yet been identified. Individuals with an inherited risk for ovarian cancer form a special risk group. (Refer to the PDQ summaries on Cancer Genetics Overview; Genetics of Medullary Thyroid Cancer; and Genetics of Prostate Cancer for more information.)
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Schmeler KM, Lynch HT, Chen LM, et al.: Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med 354 (3): 261-9, 2006.
Rebbeck TR, Lynch HT, Neuhausen SL, et al.: Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 346 (21): 1616-22, 2002.
Offit K, Kauff ND: Reducing the risk of gynecologic cancer in the Lynch syndrome. N Engl J Med 354 (3): 293-5, 2006.
Hankinson SE, Hunter DJ, Colditz GA, et al.: Tubal ligation, hysterectomy, and risk of ovarian cancer. A prospective study. JAMA 270 (23): 2813-8, 1993.
Cramer DW, Hutchison GB, Welch WR, et al.: Determinants of ovarian cancer risk. I. Reproductive experiences and family history. J Natl Cancer Inst 71 (4): 711-6, 1983.
Stratton JF, Pharoah P, Smith SK, et al.: A systematic review and meta-analysis of family history and risk of ovarian cancer. Br J Obstet Gynaecol 105 (5): 493-9, 1998.
Garg PP, Kerlikowske K, Subak L, et al.: Hormone replacement therapy and the risk of epithelial ovarian carcinoma: a meta-analysis. Obstet Gynecol 92 (3): 472-9, 1998.
Anderson GL, Judd HL, Kaunitz AM, et al.: Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial. JAMA 290 (13): 1739-48, 2003.
Koch M, Gaedke H, Jenkins H: Family history of ovarian cancer patients: a case-control study. Int J Epidemiol 18 (4): 782-5, 1989.
Calle EE, Rodriguez C, Walker-Thurmond K, et al.: Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348 (17): 1625-38, 2003.
Schouten LJ, Goldbohm RA, van den Brandt PA: Height, weight, weight change, and ovarian cancer risk in the Netherlands cohort study on diet and cancer. Am J Epidemiol 157 (5): 424-33, 2003.
Engeland A, Tretli S, Bj�rge T: Height, body mass index, and ovarian cancer: a follow-up of 1.1 million Norwegian women. J Natl Cancer Inst 95 (16): 1244-8, 2003.
Cramer DW, Liberman RF, Titus-Ernstoff L, et al.: Genital talc exposure and risk of ovarian cancer. Int J Cancer 81 (3): 351-6, 1999.
Wong C, Hempling RE, Piver MS, et al.: Perineal talc exposure and subsequent epithelial ovarian cancer: a case-control study. Obstet Gynecol 93 (3): 372-6, 1999.