Ovarian cancer risk

Preventable cases

Ovarian cancer cases are preventable, UK, 2015

 

Caused by obesity

Ovarian cancer cases caused by overweight and obesity, UK, 2015

 

Caused by smoking

Ovarian cancer cases caused by smoking, UK, 2015

 

Caused by occupation

Ovarian cancer cases caused by workplace exposures, UK, 2015

 

The estimated lifetime risk of being diagnosed with ovarian cancer is 1 in 50 (2%) for females born after 1960 in the UK.[1]

These figures take account of the possibility that someone can have more than one diagnosis of ovarian cancer in their lifetime (‘Adjusted for Multiple Primaries’ (AMP) method).[2]

References

  1. Lifetime risk estimates calculated by the Statistical Information Team at Cancer Research UK. Based on Office for National Statistics (ONS) 2016-based Life expectancies and population projections. Accessed December 2017, and Smittenaar CR, Petersen KA, Stewart K, Moitt N. Cancer Incidence and Mortality Projections in the UK Until 2035. Brit J Cancer 2016. 
  2. Sasieni PD, Shelton J, Ormiston-Smith N, et al. What is the lifetime risk of developing cancer?: The effect of adjusting for multiple primaries. Br J Cancer, 2011. 105(3): p. 460-5. 

About this data

Data is for UK, past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961, ICD-10 C56-C57.4.

The calculations used past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961 to project risk over the lifetime of those born in 1961 (cohort method).[1] Projections are based on observed incidence and mortality rates and therefore implicitly include changes in cancer risk factors, diagnosis and treatment.

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11% of ovarian cancer cases in the UK are preventable.[1]

Ovarian cancer risk is associated with a number of risk factors.[2-4]

Ovarian Cancer Risk Factors

  Increases risk Decreases risk
'Sufficient' or 'convincing' evidence
  • Asbestos
  • Hormone replacement therapy (HRT) (oestrogen-only)
  • Tobacco smoking
  • Adult-attained height
  • Body fatness[a]
  • Oestrogen-progestogen contraceptives
'Limited' or 'probable' evidence
  • Talc-based body powder (perineal use)
  • X-radiation, gamma radiation
 

International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications.

a IARC classifies evidence on body fatness as sufficient, WCRF/AICR classifies evidence on body fatness as probable

See also

Want to generate bespoke preventable cancers stats statements? Download our interactive statement generator.

Find out more about the definitions and evidence for this data

Learn how attributable risk is calculated

References

  1. Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018.
  2. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 122. Accessed October 2018.
  3. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med. 2016 Aug 25;375(8):794-8.
  4. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed October 2018.
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International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classify the role of this risk factor in cancer development.[1,2] 7% of ovarian cancer cases in the UK are caused by overweight and obesity.[3]

Ovarian cancer risk among hormone replacement therapy (HRT) never-users is 10% higher per 5-unit body mass index (BMI) increment, a meta-analysis showed. [4] Ovarian cancer risk among HRT ever-users (presumably postmenopausal) is 5% lower per 5-unit BMI increment.[4] Ovarian cancer risk may only be increased in women with BMI above 28, a meta-analysis showed.[5]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] 4% of ovarian cancer cases in the UK are caused by post-menopausal hormones.[2]

Ovarian cancer risk is 37% higher in current or recent users of hormone replacement therapy (HRT), compared with never-users, a meta-analysis showed.[3] This association may be limited to serous and endometrioid ovarian tumours.[3]

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Family history

Around 3% of ovarian cancer cases occur in women with a family history of ovarian cancer, a cohort study showed.[1

Ovarian cancer risk is 2.7-3.5 times higher in women whose mother or sister has/had ovarian cancer, compared with women with no such family history, cohort studies have shown; risk may be higher if the affected relative was diagnosed at a younger age.[2,3]

BRCA1 and BRCA2

Inherited conditions account for 5-15% of ovarian cancer cases; the majority of these hereditary cases are linked with BRCA1/2 mutations.[4]

Ovarian cancer risk is up to 65% higher in women with BRCA1 mutation, and up to 35% higher in women with BRCA2 mutation, versus women without these genes.[5,6]

Lynch syndrome

Around 7% of women with Lynch syndrome develop ovarian cancer by age 70, a pooled analysis showed.[7

Peutz-Jeghers syndrome

Around 21% of women with Peutz-Jeghers syndrome develop ovarian cancer aged 15-64, a meta-analysis showed.[8]

References

  1. Granstrom C, Sundquist J, Hemminki K. Population attributable fractions for ovarian cancer in Swedish women by morphological type. Br J Cancer 2008; 98(1):199-205.
  2. Jervis S, Song H, Lee A, et al. Ovarian cancer familial relative risks by tumour subtypes and by known ovarian cancer genetic susceptibility variants. J Med Genet 2014;51(2):108-13.
  3. Hemminki K, Sundquist J, Brandt A. Incidence and mortality in epithelial ovarian cancer by family history of any cancer. Cancer 2011;117(17):3972-80.
  4. Lynch HT, Snyder C, Casey MJ. Hereditary ovarian and breast cancer: what have we learned? Ann Oncol 2013;24 Suppl 8:viii83-viii95.
  5. Mavaddat N, Peock S, Frost D, et al. Cancer risks for BRCA1 and BRCA2 mutation carriers: results from prospective analysis of EMBRACE. J Natl Cancer Inst 2013;105(11):812-22.
  6. Watson P, Vasen HF, Mecklin JP, et al. The risk of extra-colonic, extra-endometrial cancer in the Lynch syndrome. Int J Cancer 2008;123(2):444-9.
  7. Giardiello FM, Brensinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology 2000;119(6):1447-53.
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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] Less than 1% of ovarian cancer cases in the UK are caused by smoking.[2]

Mucinous ovarian cancer risk is 31-49% higher in current smokers compared with never-smokers, meta- and pooled analyses have shown.[3,4] Risk increases with smoking duration.[3,4

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

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Ovarian cancer risk is associated with factors affecting lifetime number of (and breaks between) ovulations, and/or sex hormone levels (oestrogen, progesterone and androgens). 

Ovulation causes structural changes to the ovary which may stimulate cancer development, and hormonal factors may compound this or have their own independent effects.[1-3

Having children

Ovarian cancer risk is lower in women who have had children.[4-7] Nulliparity (bearing no children) plus not breastfeeding are probably the mechanisms underlying

Higher ovarian cancer risk in infertile women, including those treated with ovarian stimulating drugs.[8-10]

Reproductive organ surgery

7-31% lower risk (though some evidence of higher risk in women undergoing hysterectomy in more recent years, perhaps due to changes in average age at hysterectomy, surgical technique, or use of hormone replacement therapy (HRT) following hysterectomy.[11,12]

Ovarian cancer risk is 30% lower in women who have had a tubal ligation, compared with those who haven’t, a meta-analysis showed.[11]

References

  1. Jayson GC, Kohn EC, Kitchener HC, et al. Ovarian cancer. Lancet 2014;384(9951):1376-88.
  2. Lukanova A, Kaaks R. Endogenous hormones and ovarian cancer: epidemiology and current hypotheses. Cancer Epidemiol Biomarkers Prev 2005;14(1):98-107.
  3. Risch HA. Hormonal etiology of epithelial ovarian cancer, with a hypothesis concerning the role of androgens and progesterone. J Natl Cancer Inst 1998;90(23):1774-86.
  4. Högnäs E, Kauppila A, Pukkala E, et al. Cancer risk in women with 10 or more deliveries. Obstet Gynecol 2014;123(4):811-6.
  5. Bodelon C, Wentzensen N, Schonfeld SJ, et al. Hormonal risk factors and invasive epithelial ovarian cancer risk by parity. Br J Cancer 2013;109(3):769-76.
  6. Setiawan VW, Yang HP, Pike MC, et al. Type I and II endometrial cancers: have they different risk factors? J Clin Oncol 2013;31(20):2607-18.
  7. Li LL, Zhou J, Qian XJ, et al. Meta-analysis on the possible association between in vitro fertilization and cancer risk. Int J Gynecol Cancer 2013;23(1):16-24.
  8. Tworoger SS, Fairfield KM, Colditz GA, et al. Association of oral contraceptive use, other contraceptive methods, and infertility with ovarian cancer risk. Am J Epidemiol 2007;166(8):894-901.
  9. Jensen A, Sharif H, Olsen JH, et al. Risk of breast cancer and gynecologic cancers in a large population of nearly 50,000 infertile Danish women. Am J Epidemiol 2008; 168(1):49-57.
  10. Rice MS, Murphy MA, Tworoger SS. Tubal ligation, hysterectomy and ovarian cancer: A meta-analysis. J Ovarian Res 2012;5(1):13.
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Endometriosis

Ovarian cancer risk is 27-80% higher in women with endometriosis Open a glossary item, versus women without the disease and the general population respectively, a meta-analysis showed.[1] The association may differ by tumour type.[1]

Diabetes

Ovarian cancer risk is 20-55% higher in diabetics compared with non-diabetics, meta-analyses have shown.[2,3]

Ovarian cancer risk among diabetics may be slightly higher in insulin users versus non-users.[4] Ovarian cancer risk among diabetics is not associated with metformin or pioglitazone use versus non-use.[5,6]

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1]

Ovarian cancer risk is 24-35% higher in women who have ever used body powder perineally/genitally versus those who have not, meta- and pooled analyses of case-controls studies have shown.[2,3] However, recall bias (cases more likely than controls to recall exposure to possible risk factors) may have influenced this, as ovarian cancer risk is not associated with perineal powder use in cohort studies.[3,4] Ovarian cancer risk is not associated with non-genital talc-based body powder use.[5]

This association with ovarian cancer risk may be due to the mineral talc in body powders, though not all body powders today contain talc; it may also be due to asbestos traces in some body powders made before the 1970s.[3]

Ovarian cancer risk is not associated with non-genital talc-based body powder use.[5]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 122. Accessed October 2018.
  2. Terry KL, Karageorgi S, Shvetsov YB, et al. Genital powder use and risk of ovarian cancer: a pooled analysis of 8,525 cases and 9,859 controls. Cancer Rev Pres (Phila) 2013;6(8):811-21.
  3. Langseth H, Hankinson SE, Siemiatycki J, et al. Perineal use of talc and risk of ovarian cancer. J Epidemiol Community Health 2008;62(4):358-60.
  4. Houghton SC, Reeves KW, Hankinson SE, et al. Perineal powder use and risk of ovarian cancer. J Natl Cancer Inst 2014;106(9). pii: dju208.
  5. Terry KL, Karageorgi S, Shvetsov YB, et al. Genital powder use and risk of ovarian cancer: a pooled analysis of 8,525 cases and 9,859 controls. Cancer Rev Pres (Phila) 2013;6(8):811-21.
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International Agency for Research on Cancer (IARC) classifies the role of this risk factor as protective against ovarian cancer.[1] 18% of ovarian cancer cases are prevented by oral contraceptive (OC) use.[2]

Ovarian cancer risk is 25-28% lower in women who have ever used OCs compared with never-users, a meta-analysis showed.[3] Risk reduces further with longer duration of OC use and is more than halved with 10+ years' use, a meta-analysis showed.[3] Ovarian cancer risk in OC ever-users remains reduced for at least 30 years after last use of OCs, though the protection may diminish over time.[3,4]

Among BRCA1/2 mutation carriers, ovarian cancer risk is almost halved among OC ever-users compared with never-users, a meta-analysis showed.[5]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 122. Accessed October 2018.
  2. Calculated by the Statistical Information Team at Cancer Research UK, 2018. Based on Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018.
  3. Havrilesky LJ, Gierisch JM, Moorman PG, et al. Oral contraceptive use for the primary prevention of ovarian cancer. Evid Rep Technol Assess (Full Rep). 2013;(212):1-514.
  4. Collaborative Group on Epidemiological Studies of Ovarian Cancer, Beral V, Doll R, Hermon C, et al. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet 2008;371(9609):303-14.
  5. Moorman PG, Havrilesky LJ, Gierisch JM, et al. Oral Contraceptives and Risk of Ovarian Cancer and Breast Cancer Among High-Risk Women: A Systematic Review and Meta-Analysis [PDF]. J Clin Oncol. 2013;31(33):4188-98.Oct 21.
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Ovarian cancer risk is 24-30% lower in women who have ever breastfed, versus those who have never done so, meta-analyses have shown; risk decreases further with longer breastfeeding duration.[1-4] Breastfeeding and having more children may have a synergistic effect on decreased ovarian cancer risk.[4]

References

  1. Li DP, Du C, Zhang ZM, et al. Breastfeeding and ovarian cancer risk: a systematic review and meta-analysis of 40 epidemiological studies. Asian Pac J Cancer Prev 2014;15(12):4829-37.
  2. Luan NN, Wu QJ, Gong TT, et al. Breastfeeding and ovarian cancer risk: a meta-analysis of epidemiologic studies. Am J Clin Nutr 2013;98(4):1020-31.
  3. Chowdhury R, Sinha B, Sankar MJ, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015 Dec;104(467):96-113.
  4. Sung HK, Ma SH, Choi JY, et al. The Effect of Breastfeeding Duration and Parity on the Risk of Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis. J Prev Med Public Health. 2016 Nov;49(6):349-366.
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