Epithelial ovarian cancer is the commonest cancer of the female genital tract. It is the sixth most common cancer in the United States. The incidence is 33 cases per 100,000 women aged ≥50 years; the lifetime risk of a woman in the United States developing ovarian cancer is approximately 1 in 70 (1.7%) (1). 90% of ovarian cancers are epithelial in origin, accounting for 21,650 women diagnosed with ovarian cancer in 2008. It is the fifth leading cause of cancer death in women, accounting for 4% of all new cancer diagnoses and 5% of all cancer deaths. It is estimated that ovarian cancer will result in 15,520 deaths in 2008 in the United States (2).
Ovarian cancer is more common in industrialized nations, with the highest rate among women in Scandinavian countries (21 cases per 100,000 in Sweden). The lifetime risk of developing ovarian cancer is highest in Sweden (1.73%), followed by the United States (1.53%), United Kingdom (1.25%), South Europe (1.11%), South America (0.87%), India (0.75%), and Japan (0.47%) (3). In most parts of Europe and North America, the incidence of ovarian cancer was constant during the decades prior to the 1990s (4). Ovarian cancer is also more common among white women than among African-American or Asian-American women in the United States (2), although the differences are narrowing (4,5). Among white women, ovarian cancer incidence rates were reported to have declined from 1973 to 1981, increased from 1981 to 1991, and then reversed again to decline significantly from 1991 to 1997 (5). Trends between 1992 and 1998 revealed a significant decline in incidence rates of 1.4% per year for all races combined, as well as significant annual declines in white and Hispanic women (6).
This cancer is predominantly a cancer of the perimenopausal and the postmenopausal period, with 80 to 90% of cases occurring after the age of 40. The incidence is higher in older women, and the median age at diagnosis is about 62 years (7). Hereditary ovarian cancers generally occur about 10 years earlier (8). Data from the Gilda Radner Foundation Registry suggest the occurrence of anticipation (9). The majority of ovarian cancer occurs sporadically in population, and only about 5 to 10% is familial (10).
Ovarian cancer accounts for more than half of the deaths from cancer that occur in women between 55 and 74 years of age, while only approximately one-quarter of ovarian cancer deaths occur in women between 35 and 54 years of age. Prognosis among women with ovarian cancer is dependent on the stage of disease at the time of diagnosis. Statistics reported during the period 1989 to 1996 estimate that the 5-year survival rate among women with localized disease was 94.6%, compared with 79.0% for women with regional disease ...