ovarian cancer

Patients with BRCA mutations should consider prophylactic ovariectomies prior to age 50 based upon this epidemiological simulation. James W. Mold, MD, MPH

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Importance Women with a BRCA1 or BRCA2 variant face a high lifetime risk of ovarian cancer and are often advised to undergo preventive surgery (bilateral salpingo-oophorectomy [BSO]) before cancer develops. The recommended age of BSO is 35 years for BRCA1 carriers and is 45 years for BRCA2 carriers, but some women choose to delay surgery until the age of menopause; there is no standard upper age at which surgery is no longer advised.

Objective To estimate the residual lifetime risk of ovarian cancer among BRCA carriers by current age and projected age at BSO.

Design, Setting, and Participants This was a prospective cohort study in an international cohort of BRCA carriers monitored for incident ovarian cancer. A life table analysis used age-specific ovarian cancer incidence rates and competing mortality rates to estimate lifetime risk of ovarian cancer among women with a BRCA1 or BRCA2 pathogenic variant with both ovaries intact and no prior ovarian cancer at baseline. Patients were recruited between 1995 and 2024 across 24 international centers, and the mean (SD) follow-up was 4.4 (3.9) years.

Exposure Timing of BSO, defined as immediate BSO, delayed BSO, or no BSO.

Main Outcome and Measures Residual lifetime risk of ovarian cancer.

Results The cohort consisted of 4286 BRCA1 and 1427 BRCA2 carriers between the ages of 30 and 74 years at baseline (mean [SD] age, 42.0 [10.8] years). There were 249 incident ovarian cancers in the follow-up period. The lifetime risk of ovarian cancer was 55.0% (95% CI, 48.8-61.9) for a BRCA1 carrier and 24.1% (95% CI, 15.1-36.6) for a BRCA2 carrier. A 30-year-old BRCA1 carrier with BSO delayed to age 50 years had a projected residual ovarian cancer risk of 23.9% (95% CI, 20.7-27.4). At age 75 years, the residual risk of ovarian cancer was estimated to be 8.4% (95% CI, 1.7-22.7) for a BRCA1 carrier and 3.7% (95% CI, 0.1-22.7) for a BRCA2 carrier.

Conclusions and Relevance The residual risk of ovarian cancer for older women in good health is sufficiently high to consider preventive surgery. BRCA1 carriers who defer BSO until age 50 years may face a substantial risk of developing ovarian cancer.

Author/s:

Vasily Giannakeas, PhD, Adriana I. Apostol, MD, Claudia Diella, et al.

What Is Ovarian Cancer?

Megan George — Fri, 05 Dec 2025 17:01:51 +0000

Date Added:

December 5, 2025

Journal/Publication:

JAMA

Publication Date:

December 4, 2025

URL:

What Is Ovarian Cancer?

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jama.2025.18446

Keywords

MeSH

Poly(ADP-ribose) Polymerase Inhibitors

Carcinoma

Ovarian Epithelial

Minimally Invasive Surgical Procedures

Poly(ADP-ribose) Polymerases

Fallopian Tubes

Endometriosis

biopsy

Information for patients about ovarian cancer. James W. Mold, MD, MPH

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Ovarian cancer is a malignancy of the ovary, the female reproductive organ that produces eggs.

How Common Is Ovarian Cancer?
Among women worldwide, ovarian cancer is the eighth most common malignancy and cause of cancer death. In 2022, ovarian cancer was diagnosed in about 325 000 individuals and caused 206 839 deaths worldwide. In 2025, it is estimated that 20 890 US women will be diagnosed with ovarian cancer and 12 730 will die of it.1

What Are the Risk Factors for Ovarian Cancer?
Risk factors for ovarian cancer include older age (the most common age at diagnosis is 63 years), a family history of breast cancer or ovarian cancer, endometriosis (a chronic inflammatory disease in which uterine lining cells are found outside of the uterus), and never having given birth. About 25% of ovarian cancers are due to inherited genetic variants, primarily in BRCA1 and BRCA2 genes.

What Are the Symptoms of Ovarian Cancer?
At the time of diagnosis, most patients with ovarian cancer have symptoms such as abdominal pain, bloating, urgent or frequent urination, and/or increased abdominal size. Signs and symptoms of advanced ovarian cancer may include a mass in the abdominal area, weight loss, and trouble breathing due to abdominal swelling or from fluid surrounding the lungs.

How Is Ovarian Cancer Diagnosed and Staged?
Ovarian cancer is often diagnosed and staged based on findings from a pelvic ultrasound, abdominal computed tomography (CT) scan, and/or abdominal magnetic resonance imaging (MRI). Total-body positron emission tomography (PET) can detect cancer that has spread to more distant sites in the body. To help with staging, some patients may undergo diagnostic laparoscopy, a minimally invasive surgical procedure, in which clinicians look for a tumor within the abdomen and perform biopsies to assess for ovarian cancer.

Stage I ovarian cancer is limited to the ovary or fallopian tube. Stage II cancer has spread beyond the ovaries and fallopian tubes but is still confined within the pelvis. Stage III cancer involves sites outside the pelvis such as nearby lymph nodes or other areas of the abdomen. Stage IV cancer involves organs or tissues outside the abdominal cavity, such as the liver, spleen, or lungs.

How Is Ovarian Cancer Treated?
All patients diagnosed with ovarian cancer should undergo genetic testing, including for BRCA1/2 variants, to help guide treatment and counseling. First-line treatment for patients with early-stage (I and II) ovarian cancer is surgery, including removal of both ovaries and fallopian tubes, the uterus, lymph nodes, and fatty tissue covering the abdominal organs, followed by chemotherapy. Patients with stage I cancer who are considering having children may undergo more limited surgery with removal of the cancerous ovary and fallopian tube, leaving in place the other ovary and fallopian tube and the uterus.

Treatment for patients with stages III and IV (advanced) ovarian cancer includes both surgery and chemotherapy, often combined with individualized targeted therapies such as bevacizumab and/or poly–ADP ribose polymerase (PARP) inhibitors.

Prognosis After Treatment for Ovarian Cancer
Patients with stages I and II ovarian cancer have a 5-year overall survival rate of 70% to 95%. The 5-year overall rate for stages III and IV ovarian cancer is 10% to 40%. However, 5-year survival is about 70% among patients with advanced-stage ovarian cancer who have BRCA genetic variants and are treated with PARP inhibitors.

Author/s:

Rebecca Voelker

Ovarian Cancer: A Review

Megan George — Fri, 25 Jul 2025 13:29:18 +0000

Date Added:

July 25, 2025

Journal/Publication:

JAMA

Publication Date:

July 21, 2025

URL:

Ovarian Cancer: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.9495

Keywords

Obstetrics and Gynecology

MeSH

Neoplasms, Glandular and Epithelial

Salpingo-oophorectomy

Lymph Node Excision

Chemotherapy, Adjuvant

Cytoreduction Surgical Procedures

A review of what we currently know about ovarian cancer. James W. Mold, MD, MPH

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Importance: Ovarian cancer is the eighth most common cause of cancer and cancer death in women worldwide. In 2022, ovarian cancer was diagnosed in approximately 324 398 individuals, and 206 839 died of ovarian cancer worldwide. In 2025, it is estimated that 20 890 US women will be diagnosed with ovarian cancer and 12 730 patients will die of ovarian cancer.

Observations: Approximately 90% of ovarian cancers are epithelial malignancies, of which 70% to 80% are high-grade serous ovarian cancers. Less common epithelial subtypes include endometrioid, clear cell, low-grade serous, mucinous, and carcinosarcoma. The median age at diagnosis of ovarian cancer is 63 years. Risk factors include older age, family history of breast or ovarian cancer, endometriosis, and nulliparity. Hereditary factors are associated with 25% of cases, predominantly linked to BRCA1/2 gene variants. At diagnosis, approximately 95% of patients experience nonspecific symptoms, such as abdominal pain, bloating, and urinary urgency and frequency, and about 80% have advanced-stage disease (stage III-IV), including extrapelvic disease, ascites, and abdominal masses. Diagnostic and staging evaluation includes pelvic ultrasound; computed tomography of the chest, abdomen, and pelvis; and serum tumor markers such as carbohydrate antigen 125, carbohydrate antigen 19-9, and carcinoembryonic antigen. First-line treatment for early-stage ovarian cancer, defined as limited to the ovary or fallopian tube (stage I) or confined to the pelvis (stage II), is surgery (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy), followed by adjuvant chemotherapy (carboplatin and paclitaxel). With treatment, early-stage ovarian cancer has a 5-year overall survival of 70% to 95%. Advanced-stage ovarian cancer may be treated with primary cytoreductive surgery (removal of all visible cancer in the abdominal cavity) and adjuvant chemotherapy (carboplatin and paclitaxel) or with neoadjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy. Most patients with advanced-stage ovarian cancer receive maintenance therapy with bevacizumab (a monoclonal antibody that blocks angiogenesis) and/or poly–adenosine diphosphate ribose polymerase (PARP) inhibitors. With treatment, the 5-year overall survival rate for advanced-stage ovarian cancer is 10% to 40%. However, individuals with BRCA-related gene variants have a 5-year overall survival rate of approximately 70% with PARP inhibitor treatment. Despite an initial remission rate of 80%, approximately 75% of patients with advanced-stage disease have ovarian cancer relapse within 2 years.

Conclusions and Relevance: Approximately 21 000 women are diagnosed with ovarian cancer annually in the US, and approximately 80% have advanced-stage ovarian cancer at diagnosis. First-line treatment of early-stage ovarian cancer is surgery and adjuvant platinum-based chemotherapy. Treatment of advanced-stage ovarian cancer includes cytoreductive surgery, platinum-based chemotherapy, and targeted maintenance therapies such as bevacizumab and/or PARP inhibitors.

Author/s:

Giuseppe Caruso, MD, S. John Weroha, MD, PhD, William Cliby, MD

Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement.

Brian Desmarais — Wed, 21 Aug 2019 19:42:45 +0000

Date Added:

August 21, 2019

Journal/Publication:

Journal of the American Medical Association

Publication Date:

August 20, 2019

URL:

Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement.

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.10987

Keywords

MeSH

early detection of cancer

Genetic Counseling

I suspect you are already doing this, but since it is making a splash on the TV news programs, I thought you ought to see it. James W. Mold, MD, MPH

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IMPORTANCE:

Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased riskfor breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases.

OBJECTIVE:

To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.

EVIDENCE REVIEW:

The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed with BRCA-related cancer, as well as those with a previous diagnosis of breast, ovarian, tubal, or peritoneal cancer who have completed treatment and are considered cancer free. In addition, the USPSTF reviewed interventions to reduce the risk for breast, ovarian, tubal, or peritoneal cancer in women with potentially harmful BRCA1/2 mutations, including intensive cancer screening, medications, and risk-reducing surgery.

FINDINGS:

For women whose family or personal history is associated with an increased risk for harmful mutations in the BRCA1/2 genes, or who have an ancestry associated with BRCA1/2 gene mutations, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are moderate. For women whose personal or family history or ancestry is not associated with an increased risk for harmful mutations in the BRCA1/2 genes, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are small to none. Regardless of family or personal history, the USPSTF found adequate evidence that the overall harms of risk assessment, genetic counseling, genetic testing, and interventions are small to moderate.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation).

Author/s:

US Preventive Services Task Force

Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement

Jeffrey Wilson — Thu, 23 Aug 2018 16:26:38 +0000

Date Added:

November 1, 2018

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

Publication Date:

February 13, 2018

Issue:

Volume:

319

Pages:

588-594

URL:

Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2017.21926

Keywords

ovarian cancer

screening

PMID (1):

29450531

MeSH

ovarian neoplasms

unnecessary procedures

The USPSTF found good evidence that ovarian cancer screening causes more harm than good.

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IMPORTANCE:

With approximately 14 000 deaths per year, ovarian cancer is the fifth most common cause of cancer death among US women and the leading cause of death from gynecologic cancer. More than 95% of ovarian cancer deaths occur among women 45 years and older.

OBJECTIVE:

To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on screening for ovarian cancer.

EVIDENCE REVIEW:

The USPSTF reviewed the evidence on the benefits and harms of screening for ovarian cancer in asymptomatic women not known to be at high risk for ovarian cancer (ie, high risk includes women with certain hereditary cancer syndromes that increase their risk for ovarian cancer). Outcomes of interest included ovarian cancer mortality, quality of life, false-positive rate, surgery and surgical complication rates, and psychological effects of screening.

FINDINGS:

The USPSTF found adequate evidence that screening for ovarian cancer does not reduce ovarian cancer mortality. The USPSTF found adequate evidence that the harms from screening for ovarian cancer are at least moderate and may be substantial in some cases, and include unnecessary surgery for women who do not have cancer. Given the lack of mortality benefit of screening, and the moderate to substantial harms that could result from false-positive screening test results and subsequent surgery, the USPSTF concludes with moderate certainty that the harms of screening for ovarian cancer outweigh the benefit, and the net balance of the benefit and harms of screening is negative.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends against screening for ovarian cancer in asymptomatic women. (D recommendation) This recommendation applies to asymptomatic women who are not known to have a high-risk hereditary cancer syndrome.

Author/s:

Grossman, David C., Curry, Susan J., Owens, Douglas K., Barry, Michael J., Davidson, Karina W., Doubeni, Chyke A., Epling, John W. Jr., Kemper, Alex R., Krist, Alex H., Kurth, Ann E., Landefeld, Seth, Mangione, Carol M., Phipps, Maureen G., Silverstein, Michael, Simon, Melissa A., Tseng, Chien-Wen