Ovarian cancer is relatively uncommon compared to other cancers, accounting for roughly 1 in 78 women over a lifetime. About 19,000 to 20,000 new cases are diagnosed each year in the United States. Despite its lower frequency, it causes more deaths than any other cancer of the female reproductive system, largely because most cases aren’t caught until the disease has already spread.
How Rates Have Changed Over Time
Ovarian cancer has been getting less common for two decades. Between 2000 and 2019, the age-adjusted incidence dropped from 15.5 to 12.1 cases per 100,000 women, an average decline of about 1.4% per year. That decline accelerated in the second half of the decade: from 2015 to 2019, rates fell by 2.4% annually. Researchers attribute this partly to the protective effects of oral contraceptive use, which became widespread in earlier generations, and partly to more women having risk-reducing surgeries when genetic testing reveals elevated risk.
Who Gets Diagnosed
Ovarian cancer is predominantly a disease of older women. The median age at diagnosis is 63, and most cases occur in women between their late 50s and early 70s. It’s rare in women under 40, though certain subtypes (like germ cell tumors) can appear in younger women.
Geography plays a role, too. Eastern Europe has the highest incidence rates in the world, with Latvia reporting 15.3 cases per 100,000 women. Middle Africa has the lowest rates. In the U.S., non-Hispanic white women have historically had higher incidence than Black or Hispanic women, though those patterns shift when you look at outcomes rather than raw case counts.
Genetic Risk Factors
For most women, the lifetime risk of ovarian cancer sits between 1% and 2%. Inherited gene mutations can dramatically change that number. Women who carry a harmful BRCA1 mutation face a 39% to 58% lifetime risk of developing ovarian cancer. For BRCA2 carriers, the range is 13% to 29%. These figures include cancers of the fallopian tubes and peritoneum, which are now understood to be closely related to ovarian cancer and are often grouped together.
Other inherited conditions also raise risk, including Lynch syndrome (a hereditary condition linked to several cancers). A strong family history of ovarian or breast cancer, even without a confirmed mutation, is worth discussing with a doctor. Genetic testing can clarify whether preventive options like surgery make sense.
Why It’s Often Found Late
Ovarian cancer has no reliable screening test for the general population. Pap smears detect cervical cancer, not ovarian cancer. Blood tests for a protein called CA-125 can be elevated in ovarian cancer but also rise with many benign conditions, making it too imprecise for routine screening. Transvaginal ultrasound has similar limitations. Large clinical trials have tested both tools in combination and found they don’t reduce deaths from the disease in average-risk women.
The symptoms of ovarian cancer are real but frustratingly vague: bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary urgency. These overlap with dozens of everyday conditions, which is why both patients and doctors often attribute them to something else. The key distinction is persistence. If these symptoms are new and occur almost daily for more than two or three weeks, they warrant investigation.
Because early detection is so difficult, the majority of cases are diagnosed at an advanced stage, when the cancer has already spread beyond the ovaries. Only about 15% to 20% of ovarian cancers are caught while still localized.
Survival by Stage
Stage at diagnosis is the single biggest factor in survival. The overall five-year relative survival rate for ovarian cancer is 52%, based on data from 2016 to 2022. That number blends very different outcomes depending on how far the cancer has spread:
- Localized (confined to the ovary): 91.9% five-year survival
- Regional (spread to nearby tissues or lymph nodes): 70.1%
- Distant (spread to distant organs): 31.5%
The gap between localized and distant survival is enormous, which is why the late-stage detection problem matters so much. Women whose cancer is found early have survival rates comparable to many other common cancers.
Racial Disparities in Outcomes
While ovarian cancer incidence is somewhat similar across racial groups, survival is not. Between 1975 and 2016, the five-year survival rate for non-Hispanic white women rose from 33% to 48%. Over that same period, the rate for Black women actually declined slightly, from 44% to 41%. That widening gap reflects differences in access to specialized care, timeliness of diagnosis, and the types of treatment received. Black and Hispanic women with ovarian cancer are less likely to receive care at high-volume cancer centers, where outcomes tend to be better.
Factors That Lower Risk
Several factors are consistently associated with reduced ovarian cancer risk. Using oral contraceptives for five or more years cuts risk by roughly 50%, and the protection lasts for decades after stopping. Pregnancy and breastfeeding both lower risk, likely because they reduce the total number of ovulation cycles over a lifetime. Tubal ligation and hysterectomy also appear protective, possibly by blocking potential carcinogens from reaching the ovaries through the fallopian tubes.
On the other hand, factors linked to higher risk include never having been pregnant, starting menstruation early, reaching menopause late, and using hormone replacement therapy (particularly estrogen-only formulations) for extended periods. Obesity modestly increases risk for certain subtypes. Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, is associated with a higher risk of specific ovarian cancer types, particularly clear cell and endometrioid subtypes.