Ovarian Cancer Risk Factors and Prevention

Ovarian cancer is a complex disease influenced by a variety of risk factors, both genetic and environmental. According to the World Health Organization, ovarian cancer is among the top causes of cancer-related deaths in women. (WHO, 2024)

Among these risk factors, age is particularly significant, with the highest incidence observed in women over 50 years old. Notably, approximately 12.1% of cases occur in women younger than 44 (Nayar, 2024). Moreover, family history—particularly of ovarian or breast cancer—and inherited mutations in the BRCA1 and BRCA2 genes substantially increase the risk (Nayar, 2024; Jara-Rosales et al., 2024). In addition, reproductive factors such as nulliparity, early menarche, and late menopause are also associated with elevated risk (Nayar, 2024).

When considering lifestyle influences, factors such as smoking and alcohol consumption have been linked to higher ovarian cancer risk, while physical activity, interestingly, does not show a significant association (Jibril et al., 2024). Regarding hormonal aspects, the use of hormonal contraceptives presents a complex relationship with ovarian cancer risk: some studies suggest a protective effect, while others indicate increased risk depending on dosage, duration, and individual context (Jibril et al., 2024; Zheng et al., 2024).

Conversely, greater parity and the use of oral contraceptives are generally associated with a reduced risk. In contrast, conditions such as endometriosis and the use of menopausal hormone therapy have been shown to increase the risk (Madakkatel et al., 2024; Zheng et al., 2024). Furthermore, socioeconomic factors—such as limited education and restricted access to healthcare—play a significant role, especially in regions like South America, where genetic predispositions (e.g., BRCA mutations) are more prevalent (Jara-Rosales et al., 2024). The ovulation hypothesis, which posits that repeated ovulation increases the likelihood of DNA damage, has also gained attention, although the influence of fertility treatments remains inconclusive (Nayar, 2024).

Among modifiable lifestyle choices, obesity and smoking stand out as significant contributors to ovarian cancer risk. Indeed, obesity is a well-documented risk factor, with several mechanisms proposed to explain this association. It contributes to a pro-inflammatory environment in the peritoneal cavity, which supports the survival and dissemination of ovarian cancer cells, as demonstrated in high-fat diet-induced mouse models (Shea et al., 2024).

This inflammatory state is characterized by changes in immune cell composition—such as an increase in myeloid-derived suppressor cells and a decrease in B cells—that together facilitate tumor growth and metastasis (Shea et al., 2024). Additionally, obesity is linked to a decreased M1/M2 tumor-associated macrophage ratio, which is associated with enhanced metastatic potential and reduced chemotherapy efficacy in ovarian cancer patients (Juncker-Jensen et al., 2022). Moreover, the metabolic consequences of obesity—including insulin resistance and altered levels of sex hormones—further contribute to disease pathogenesis (Jochem et al., 2017).

Smoking, another modifiable factor, has likewise been associated with increased ovarian cancer risk. According to Mendelian randomization studies, there is a causal relationship between smoking initiation and ovarian cancer incidence, emphasizing the detrimental impact smoking has on both risk and prognosis (Liu et al., 2023). Furthermore, combined exposure to smoking, obesity, and physical inactivity is associated with poorer survival outcomes, highlighting the compounded negative effects of these lifestyle factors (Minlikeeva et al., 2019).

Taken together, these findings underscore the critical importance of addressing modifiable lifestyle factors—particularly obesity and smoking—in the prevention and management of ovarian cancer, as they significantly influence both the development and progression of the disease (Beavis et al., 2016).

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