Ovarian Cancer Prevention
Ways to lower your risk
- Not every case of ovarian cancer can be prevented, but some measures lower the risk.
- Yearly checkups with ultrasound and blood tests have not been shown to reduce deaths.
- Taking birth control pills for 5 years or more is linked to about a 50% relative reduction in the risk of ovarian cancer.
- A family history of ovarian or breast cancer may be a reason for genetic counseling.
- In carriers of a harmful inherited BRCA1 or BRCA2 variant (mutation), preventive removal of both fallopian tubes and both ovaries lowers the risk of ovarian cancer by about 90% in relative terms.
- Preventive surgery is not for everyone. Its timing depends on your inherited risk, your plans for having children and the effects of menopause.
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Can ovarian cancer be prevented?
There is no way to prevent ovarian cancer completely, but some measures can lower the risk. For women at high risk, there are also more targeted options.
Are yearly checkups recommended to screen for ovarian cancer?
For women with no symptoms who are at average risk, ultrasound and CA-125 are not recommended as routine screening. These methods have not been shown to reduce deaths, and they may lead to unnecessary tests or surgery.
If someone you love has been diagnosed with this disease, know that it is usually not the result of anything you failed to do or did wrong. Many factors, including genetics, play a part in causing the disease.
Assessing your personal risk: average risk and high risk
1. Average risk: most women
If you have no personal or family history that suggests an inherited risk, and no known harmful inherited variant, you usually fall into this group. Even so, the risk is not the same for everyone in this group. Age, starting periods early, late menopause, never having given birth, endometriosis and past radiation therapy (radiotherapy) to the pelvis can change the risk, but having these factors does not mean you will definitely get the disease.
2. High risk
A harmful inherited variant (mutation) in the BRCA1 or BRCA2 gene, Lynch syndrome and some rare syndromes, such as Peutz-Jeghers syndrome, can raise the risk considerably. A family history of ovarian cancer or certain patterns of breast cancer in the family also call for a closer assessment. In these situations, genetic counseling helps work out your level of risk and choose suitable steps to lower it.
Does cancer in the family mean I will definitely get it?
No. A family history can only be a sign of higher risk. Genetic counseling helps assess your personal risk more precisely.
What lowers the risk of ovarian cancer?
Pregnancy and childbirth
Having at least one full-term pregnancy, especially before age 26, is linked to a lower risk of ovarian cancer compared with never having a full-term pregnancy. The more full-term pregnancies, the stronger this protective link becomes.
Breastfeeding
Breastfeeding is linked to a lower risk, and breastfeeding for longer may give more protection.
Tubal ligation (having your tubes tied)
Having your tubes tied (tubal ligation) for birth control has been linked to about a 30% relative reduction in the risk of ovarian cancer.
Do birth control pills help prevent ovarian cancer?
Taking birth control pills for 5 years or more has been linked to about a 50% relative reduction in the risk of ovarian cancer. Some of this effect may last for years after you stop taking them. However, combined pills can raise the risk of blood clots and can affect the risk of some other cancers. These medicines are not right for everyone; whether to start or continue them depends on your individual situation and should be decided with your doctor after weighing the benefits and risks.
What role do the fallopian tubes play in preventing ovarian cancer?
A large share of the most common type of ovarian cancer, high-grade serous cancer, starts in cells at the far end of the fallopian tube and then reaches the surface of the ovary. That is why removing the tubes can lower the risk in some situations.
Removing the fallopian tubes during other surgery
If you have finished having children and have abdominal or pelvic surgery coming up, you can talk to your doctor about having both fallopian tubes completely removed during the same operation.
This procedure, called opportunistic salpingectomy, keeps the ovaries and does not directly cause menopause.
Whether it can be done, and how much time it adds to the surgery, depends on the type of operation and your individual situation. Once both tubes have been removed, you can no longer get pregnant naturally.
Managing ovarian cancer risk in people at high inherited risk
1. Genetic counseling and testing of related genes
If ovarian cancer, breast cancer at a young age or a harmful inherited variant has been reported in your close relatives, genetic counseling can help assess your risk. If needed, genes such as BRCA1 and BRCA2, or the genes linked to Lynch syndrome, are tested.
2. Choosing an approach based on the results
If a harmful inherited variant is confirmed, options such as birth control pills or risk-reducing surgery are considered, depending on the gene involved, the level of risk, your age and your plans for having children. Specialist follow-up is an option in some situations, but it does not replace risk-reducing surgery.
Removing the tubes and ovaries is not right for everyone
Risk-reducing surgery to remove both fallopian tubes and both ovaries, called RRSO (risk-reducing salpingo-oophorectomy), lowers the risk of ovarian cancer by about 90% in relative terms in carriers of a harmful inherited BRCA1 or BRCA2 variant. This surgery is considered only for women at high risk, and only after counseling; its timing depends on the type of variant, age and plans for having children. Removing the tubes alone is not a standard alternative to this surgery for carriers of these variants.
If the surgery is done before menopause, it causes surgical menopause and can have effects such as lower bone density. For many women with no history of breast cancer, and if there is no medical reason to avoid it, hormone therapy after this surgery until around the age of natural menopause may be considered, and it should be weighed with a doctor. Even after surgery, the risk does not drop to zero: a small chance of primary peritoneal cancer remains.
How do diet and lifestyle affect the risk of ovarian cancer?
What helps your overall health
A healthy weight, regular physical activity and quitting smoking are good for general health and lower the risk of several types of cancer. Excess weight is linked to a higher risk of ovarian cancer, and smoking to a higher risk of some types of it. Even so, a healthy lifestyle does not guarantee that ovarian cancer will be prevented.
What has not been proven
No miracle food is known to prevent ovarian cancer. The link between diet and this cancer is not certain, and exaggerated percentages about any particular food should not be relied on.
Is sugar “food for cancer”?
This phrase is a misleading oversimplification. What matters is eating a balanced diet and keeping a healthy weight, rather than obsessively cutting out one food.
Four common misconceptions about preventing ovarian cancer
“A Pap smear screens the ovaries”
No. A Pap test (Pap smear; in the UK, a smear test) checks the cells of the cervix and does not show ovarian cancer.
“The HPV vaccine prevents ovarian cancer”
No. The vaccine helps protect against HPV-related cancers, including cervical cancer. HPV and genital warts do not cause ovarian cancer.
“Removing the uterus prevents ovarian cancer”
Removing the uterus (womb) does not, on its own, prevent ovarian cancer. In some situations, the lower risk comes from removing the tubes or ovaries.
“The ovaries, uterus and cervix are one organ”
They are three different areas (the ovaries, the body of the uterus and the cervix, which is the lower part of the uterus). Each one has its own type of cancer, its own ways of prevention and its own tests.
Table of factors that lower or raise the risk of ovarian cancer
Lowers the risk
- Taking birth control pills for several years
- Pregnancy and childbirth
- Long-term breastfeeding
- Tubal ligation (having your tubes tied)
- Complete removal of the tubes, when appropriate
- Risk-reducing surgery in women at high risk
Raises the risk
- Getting older
- Family history, and BRCA mutations or Lynch syndrome
- Endometriosis
- Early first period, late menopause or never having given birth
- Obesity (more limited evidence)
- Menopausal hormone therapy (more limited evidence)
Effect unclear
- Diet in general
- Drinking alcohol
- Aspirin and anti-inflammatory painkillers
- Ovulation-stimulating or fertility drugs
How are obesity and menopausal hormone therapy linked to ovarian cancer risk?
Obesity: linked to a relatively small increase in the risk of ovarian cancer; the strength of this link differs between tumor types.
Menopausal hormone therapy: current or recent use of these medicines is linked to a small increase in the risk of some types of ovarian cancer; the link is not limited to long-term use. Its benefits and risks should be weighed individually, with your doctor’s advice.
Do fertility drugs that stimulate ovulation cause cancer?
A definite link between these drugs and invasive ovarian cancer has not been proven. In some subgroups, such as women who did not get pregnant after taking clomiphene, a higher risk has been reported, but this still needs more research. If you are concerned, discuss your history of fertility treatment with a gynecologic oncologist.
Which symptoms should be checked by a doctor?
Symptoms such as persistent bloating, feeling full quickly, abdominal or pelvic pain, needing to urinate more often or changes in bowel habits that are new and keep coming back, continue or get worse are best checked by a gynecologist. These symptoms usually do not mean cancer, but it is not a good idea to ignore them either.
Frequently asked questions about preventing ovarian cancer
Can ovarian cancer be completely prevented?
No. There is no sure way to prevent it completely, but some measures lower the risk. Paying attention to persistent symptoms also matters.
Can a yearly checkup find ovarian cancer early?
For women with no symptoms who are at average risk, no test or ultrasound is effective for screening. For women with a family history or a BRCA mutation, the plan should be decided separately.
Are birth control pills good or bad for the ovaries?
Taking them for several years is linked to a lower risk of ovarian cancer, but the benefits and risks should be weighed for each person with their doctor.
Do sugar and sweets raise the risk of ovarian cancer?
No direct link has been proven for any particular food. A balanced diet and a healthy weight matter more than cutting out sugar or any single food completely.
Do Pap smears or the HPV vaccine prevent ovarian cancer?
No. Both relate to preventing or checking for diseases of the cervix, and neither screens for nor prevents ovarian cancer.
Should I have my ovaries removed to prevent ovarian cancer?
This surgery is considered only for some women at high risk, and only after counseling. Removing the ovaries causes early menopause and is not recommended for everyone.
Do fertility drugs that stimulate ovulation cause cancer?
A definite link has not been proven, and the evidence is still unclear. If you have taken these drugs and are concerned, discuss it with a gynecologic oncologist.
Ovarian or breast cancer is common in my family. What should I do?
You may be in a higher-risk group. Genetic counseling helps work out whether you need testing and what the next steps should be.
Can I have my fallopian tubes removed during another surgery?
If you are 45 or older, have no known genetic risk and have another abdominal or pelvic surgery coming up, you can raise this option with your surgeon. Removing the tubes keeps the ovaries and does not cause early menopause.
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