Ovarian cancer affects about 1 in every 90 women over their lifetime, and it can be harder to treat because it’s often caught late.
There’s also no effective screening test for ovarian cancer in people with an average risk, unlike more common cancers, such as breast cancer and cervical cancer. That’s why knowing your risk is so important.
“Having a risk factor, even a high-risk inherited genetic change, does not mean that ovarian cancer is inevitable,” says Alexander Cohen, MD, a gynecologic oncologist at RUSH MD Anderson Cancer Center. “Knowing your risk isn’t meant to create anxiety. For people with an increased risk, it can help you understand your options and take steps to reduce your risk.”
Here are some common risk factors linked to ovarian cancer — and what you can do if they apply to you.
Common risk factors for ovarian cancer
▶ Age
The risk of ovarian cancer increases with age, as about half of women diagnosed with the disease are 63 or older.
“Although age is one of the strongest risk factors for ovarian cancer, it’s obviously not something we can change,” Cohen says. “That’s why other risks factors — particularly family history and genetics — are so important.”
▶ If you have an inherited gene
Up to a quarter of ovarian cancers may be associated with an inherited cancer syndrome. The most well-known are changes in the BRCA1 and BRCA2 genes, although several other genes can also increase the risk of ovarian cancer.
For women with an inherited change in BRCA1, lifetime ovarian cancer risk can be up to 60%. For BRCA2, it is up to 30%, compared to 1% to 2% for the general population.
“Those are meaningful absolute risks, not just small increases,” Cohen says. “The good news is that identifying that inherited risk gives us an opportunity to reduce your cancer risk before it develops.”
▶ Your family history
A family history of cancer may increase your risk of ovarian cancer, even when no genetic mutation has previously been found in your family. This can include ovarian, breast, pancreatic, colon and uterine cancers.
“It’s important to know both sides of your family history, as genetic changes and risks can be inherited from either parent,” Cohen says. “For example, a history of prostate or pancreatic cancer on your father’s side can sometimes suggest a BRCA mutation.”
Families may have the same lifestyle habits, Cohen adds, such as their eating and drinking patterns and activity levels, which can also play a role. “Families often share similar lifestyles,” he says. “There may also be rare inherited gene changes associated with it.”
▶ Your reproductive history
Pregnancy, breastfeeding and the use of birth control pills are all associated with a lower risk of ovarian cancer.
“One likely reason is that they reduce the total number of times a person ovulates over a lifetime,” Cohen says. “But ovarian cancer is complex, and we now know that some of the most common ovarian cancers may begin in the fallopian tubes rather than the ovaries.”
People who have never been pregnant have a somewhat higher risk of ovarian cancer than those who have given birth.
▶ Endometriosis
Endometriosis is a common, noncancerous condition that can cause painful periods, chronic pelvic pain and infertility. It is also associated with an increased risk of rare types of ovarian cancer.
“While there is a connection between the two, having endometriosis does not mean someone is likely to develop ovarian cancer,” Cohen says. “Most people with endometriosis will not.”
Ways to help lower your risk for ovarian cancer
▶ Know your family history
Talk with family members about their cancer history, including what type of cancer they had and, if possible, how old they were when they were diagnosed.
“There are patterns in a family history that may suggest someone would benefit from genetic counseling and testing,” Cohen says. “And finding an inherited risk can matter not only for you, but for your children, siblings and other relatives.”
▶ Risk-reducing surgery for people at high risk
For women with a high inherited risk of ovarian cancer, such as those with a BRCA1 or BRCA2 mutation, removing the fallopian tubes and ovaries after having children can greatly reduce the risk of ovarian, fallopian tube and related cancers.
“This is the most effective cancer prevention strategy we have for people with a high inherited risk,” Cohen says. “But it does not reduce the risk to zero, and removing the ovaries before natural menopause has important effects. So, the decision is not simply whether to have surgery, but whether the benefit of cancer prevention outweighs the effects of early menopause.”
The recommended timing of risk-reducing surgery depends on the gene you have, your age, family history and plans for having children.
▶ Removing the fallopian tubes
For people at an average risk, removing just the fallopian tubes, called an opportunistic salpingectomy, may lower the future risk of ovarian cancer.
“The most aggressive ovarian cancers appear to start in the fallopian tube,” Cohen says. “So, if someone has completed childbearing and is already having a hysterectomy or another pelvic surgery, it is worth discussing whether the fallopian tubes should be removed at the same time.”
For people with BRCA1 or BRCA2 mutations, however, removing the fallopian tubes alone has not been proven to provide the same cancer protection as removing both the tubes and ovaries, although this approach is still being studied.
▶ Birth control pills
Birth control pills can lower the risk of ovarian cancer, and the protection can last for years after a person stops taking them. Hormonal IUDs may also lower the risk.
“I wouldn’t recommend that a patient at average risk start birth control solely to prevent ovarian cancer,” Cohen says. “But when a patient is already considering contraception — or when someone at an increased risk is trying to reduce their risk before surgery — it’s worth discussing birth control with your provider.”
▶ Maintaining a healthy lifestyle
Excess body weight may slightly increase the risk of ovarian cancer.
“Maintaining a healthy weight, exercising and taking care of your overall health are important for many reasons,” Cohen says. “But when it comes to ovarian cancer, healthy lifestyle choices are not a substitute for genetic counseling or a risk-reducing surgery, if someone has a high inherited risk.”
Pay attention to ovarian cancer symptoms
Understanding your risk is only part of the picture. Because there is no effective routine ovarian cancer screening test, it is also important to pay attention to new or persistent changes in your body.
Common early signs of ovarian cancer can include bloating, abdominal or pelvic discomfort, feeling full quickly, changes in your bowel or bladder habits, among other symptoms. If these symptoms are new or occur frequently, talk to your doctor.
“If you’re having bloating or abdominal discomfort, that certainly doesn’t mean you have ovarian cancer — symptoms aren’t a screening test," Cohen says. "What gets my attention is a symptom that is new or ongoing, particularly in someone who already has an increased risk.”
Researchers are also working to find better ways to detect ovarian cancer earlier.
“There is a tremendous amount of work being done to understand how these cancers begin and how we can identify people at risk,” Cohen says. “There’s reason to hope that ovarian cancer prevention and early detection will continue to improve, and we’re excited to be part of that.”
For more information on ovarian cancer, or to schedule an appointment with a gynecologic oncologist, visit us online or call (312) CANCER-1.
