Incidence and Mortality
Factors Associated with Ovarian Cancer

Incidence and Mortality

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.[1] It is estimated that 21,650 new cases of ovarian cancer will be diagnosed in the United States in 2008, and 15,520 women will die of this disease.[1] The median age at diagnosis is 63.[2] The prognosis for survival from ovarian cancer largely depends on the extent of disease at diagnosis.[3] The overall 5-year survival rate for ovarian cancer is lower than 50%.[3] Fewer than one fourth of women present with localized disease at diagnosis.[3]

Incidence decreased slightly from 1987 through 2002, but mortality rates remained relatively stable over this same period.[3]

Ovarian cancer is rare; the lifetime risk of being diagnosed with ovarian cancer is 1.44%.[2]

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.[4] 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.[5] Oophorectomy reduces but does not eliminate the risk of ovarian cancer because primary peritoneal carcinomatosis may occur.[6-8] A history of tubal ligation or hysterectomy with ovarian conservation is also associated with a decreased risk of ovarian cancer.[9]

Risk is increased in women with a family history of ovarian cancer,[5,10,11] with the postmenopausal use of hormone replacement therapy (also called 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.[15-17]

Age at menarche, age at menopause, or age at first live birth is unrelated to the risk of ovarian cancer.[5] 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.

References

1. American Cancer Society.: Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society, 2008. Also available online. Last accessed October 1, 2008. 
   
   
2. Ries LAG, Harkins D, Krapcho M, et al.: SEER Cancer Statistics Review, 1975-2003. Bethesda, Md: National Cancer Institute, 2006. Also available online. Last accessed October 07, 2008. 
   
   
3. Ries LAG, Eisner MP, Kosary CL, et al., eds.: SEER Cancer Statistics Review, 1975-2002. Bethesda, Md: National Cancer Institute, 2005. Also available online. Last accessed February 12, 2009. 
   
   
4. Ness RB, Cottreau C: Possible role of ovarian epithelial inflammation in ovarian cancer. J Natl Cancer Inst 91 (17): 1459-67, 1999.  [PUBMED Abstract]
   
   
5. Whittemore AS, Harris R, Itnyre J: Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol 136 (10): 1184-203, 1992.  [PUBMED Abstract]
   
   
6. 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.  [PUBMED Abstract]
   
   
7. 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.  [PUBMED Abstract]
   
   
8. Offit K, Kauff ND: Reducing the risk of gynecologic cancer in the Lynch syndrome. N Engl J Med 354 (3): 293-5, 2006.  [PUBMED Abstract]
   
   
9. 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.  [PUBMED Abstract]
   
   
10. 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.  [PUBMED Abstract]
    
    
11. 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.  [PUBMED Abstract]
    
    
12. 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.  [PUBMED Abstract]
    
    
13. 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.  [PUBMED Abstract]
    
    
14. Koch M, Gaedke H, Jenkins H: Family history of ovarian cancer patients: a case-control study. Int J Epidemiol 18 (4): 782-5, 1989.  [PUBMED Abstract]
    
    
15. 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.  [PUBMED Abstract]
    
    
16. 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.  [PUBMED Abstract]
    
    
17. Engeland A, Tretli S, Bjørge 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.  [PUBMED Abstract]
    
    
18. 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.  [PUBMED Abstract]
    
    
19. 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.  [PUBMED Abstract]
    
    

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