Ovarian cancer often does not show clear symptoms in its early stages. Understanding ovarian cancer risk factors is therefore important for monitoring and early detection. High-risk groups include women aged 50 and older, those with a family history of the disease or BRCA gene mutations, women who have never given birth, and those with endometriosis. Although some risk factors cannot be controlled, regular follow-up and early care planning can significantly improve the chances of successful treatment.
Ovarian cancer risk factors: modifiable and non-modifiable factors
There are several ovarian cancer risk factors, most of which are related to the number of ovulations and genetics. To make them easier to understand, these risk factors can be divided into the following main categories.
| Type of Ovarian Cancer Risk Factors | Key Details | Who Is at Risk for Each Factor? |
|---|---|---|
| Modifiable ovarian cancer risk factors |
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| Non-modifiable ovarian cancer risk factors |
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When ovarian cancer risk factors cannot be avoided, extra vigilance is essential
Non-modifiable ovarian cancer risk factors are factors we are born with or that change over time. These are risks that cannot be changed, so the best approach is to “accept, monitor, observe, and get checked regularly” as closely as possible.
Non-modifiable ovarian cancer risk factors and warning signs to watch for
1. Advancing age
Advancing age is one of the most important ovarian cancer risk factors. The risk increases with age, especially after menopause. Ovarian cells have undergone division and accumulated genetic abnormalities over many years, which raises the chance of abnormal changes developing. However, ovarian cancer can occur in women of any age, although the risk rises significantly between the ages of 50 and 60 (the years approaching or following menopause). At the same time, the immune system becomes less effective at eliminating abnormal cells as we grow older, making it easier for cancer cells to develop. Since aging cannot be stopped, the best approach is to strengthen the immune system and maintain good overall health consistently.
2. Genetic Mutations
One of the most important ovarian cancer risk factors is a mutation in the BRCA1 and BRCA2 genes (the same group of genes associated with breast cancer). Studies show that approximately 10–15% of ovarian cancer cases are caused by inherited genetic factors.
If abnormalities in this group of genes are detected, they become one of the most significant ovarian cancer risk factors, increasing the lifetime risk of ovarian cancer to 15-40% (compared with only 1-2% in the general female population). In addition, other hereditary conditions such as Lynch Syndrome not only increase the risk of colorectal cancer, but also raise the risk of ovarian cancer at the same time.
3. Family History
Even without genetic testing, having first-degree relatives (a mother, sister, or daughter) with ovarian cancer, or having several relatives with breast cancer, immediately increases the level of ovarian cancer risk factors. Family members often share similar genetic backgrounds and environmental influences, which is why family history is considered one of the clearest and most important ovarian cancer risk factors.
4. Reproductive History
One of the key ovarian cancer risk factors is “repeated ovulation without interruption”. Each time ovulation occurs, the surface of the ovary develops tiny injuries and the cells go through a repair process. This repeated cycle of repair may increase the chance of abnormal changes that can eventually develop into cancer cells.
Groups that require especially close monitoring
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- Women who start menstruating early (before age 12) or reach menopause late (after age 55) have a longer period of ovarian activity and more frequent ovulation than usual, which is associated with a higher risk.
- Women who have never been pregnant experience monthly ovulation without the 9-month break that occurs during pregnancy.
5. Medical History
A history of endometriosis, often referred to as a “chocolate cyst,” is also considered one of the ovarian cancer risk factors. This condition can cause chronic inflammation in the pelvis, which may trigger changes in ovarian cells and increase the likelihood of certain types of ovarian cancer developing. Although the overall risk is not very high, it is still important to monitor symptoms closely and maintain regular follow-up.
Because age and genetic factors cannot be changed, the best approach for managing ovarian cancer risk factors is to
- Watch for symptoms such as frequent bloating or lower abdominal pain
- Have annual health checkups, especially pelvic examinations and lower abdominal ultrasound
- Consider genetic testing if there is a clear family history, as a blood test for BRCA gene mutations can help with early prevention planning
How to manage ovarian cancer risk factors that cannot be changed
Recognizing that you have non-avoidable ovarian cancer risk factors does not mean you will definitely develop cancer. Instead, it means “knowing earlier so you can plan how to take care of yourself”, giving you an important advantage in seeking timely care and treatment.
Genetic testing is like “looking at the body’s blueprint” to identify hidden defects that may lead to serious diseases in the future. When it comes to ovarian cancer, genetic testing offers significant value in understanding ovarian cancer risk factors in three main ways, as follows
1. Risk Assessment
Genetic testing helps determine whether your “chance” of developing ovarian cancer is higher than average, especially in relation to key ovarian cancer risk factors such as BRCA1 and BRCA2
- The general population has only about a 1-2% lifetime risk of ovarian cancer
- People with a BRCA1 mutation have a significantly increased risk of 39-44%*
- People with a BRCA2 mutation have a risk of approximately 11-17%* *Data from the U.S. National Cancer Institute (NCI). Epidemiological meta-analysis data report the average cumulative lifetime risk of ovarian cancer in women (up to age 70-80).
2. Preventive Options
If genetic testing comes back “positive,” meaning a mutation is found, doctors may recommend preventive options that can reduce ovarian cancer risk factors and lower the risk almost completely, such as
- Preventive surgery Doctors may recommend removing the ovaries and fallopian tubes at the appropriate age and after childbearing is complete, which can reduce the risk of ovarian cancer by more than 90%
- Oral contraceptive use to help lower long-term risk under a doctor’s guidance
- More frequent screening such as ultrasound and blood tests every 6 months instead of once a year
3. Tailored Treatment
In cases where cancer has already been diagnosed, knowing the genetic test results can help doctors choose the most appropriate “targeted therapy” (Targeted Therapy). This is especially important when inherited ovarian cancer risk factors such as BRCA mutations are involved. Today, some medications (such as PARP inhibitors) work particularly well in ovarian cancer patients with BRCA gene mutations, making treatment more effective and reducing the chance of recurrence.
Genetic testing does not tell us whether we already “have” cancer
But it shows how high our risk may be based on ovarian cancer risk factors, so we can choose the safest path for ourselves
Modifiable "ovarian cancer risk factors" and how to make changes to "reduce the risk"
Daily habits can affect ovarian cancer risk factors in several ways, and many of these can be adjusted starting today. These are factors we can “choose” and “modify” to help reduce the risk of developing the disease.
1. Body Mass Index - BMI
Research shows that women with a body mass index (BMI) above the healthy range, especially those with obesity, may have higher ovarian cancer risk factors than women of normal weight. Excess body fat can affect hormone levels and promote chronic inflammation, creating a biological environment that may support the growth of cancer cells.
Exercising for at least 150 minutes per week and focusing on a high-fiber diet while reducing sugar and saturated fat can help regulate hormones, lower ovarian cancer risk factors, and improve overall health.
2. Contraceptive Choice
The use of “oral contraceptive pills” (Oral Contraceptives) continuously for more than 5 years has been found to reduce the risk of ovarian cancer by 30-50%. This is because oral contraceptives suppress ovulation, allowing the ovaries to “rest” and reducing damage to the ovarian surface caused by repeated ovulation.
If there are no plans for pregnancy in the near future, using oral contraceptives as a preventive option to help reduce ovarian cancer risk factors—especially in those with a family history—can be a good strategy. However, this approach should be discussed with a gynecologic oncologist before making a decision, so that its suitability and both the short-term and long-term side effects can be carefully considered.
3. Dietary Habits
Regular consumption of processed red meat products (such as sausages and bacon) and high-fat foods may increase ovarian cancer risk factors due to the buildup of carcinogenic substances in the body. It is better to focus on “cancer-fighting foods” such as cruciferous vegetables (broccoli, Brussels sprouts), antioxidant-rich berries, and healthy fats from fish or plant-based sources, as these are better for overall health.
4. Smoking
Although smoking is primarily associated with lung cancer, in ovarian cancer the toxins in cigarettes are strongly linked to Mucinous ovarian cancer (the mucus-producing type). Women who smoke have up to a 2-fold higher risk of developing mucinous ovarian cancer than women who have never smoked. This risk also increases according to the amount and duration of smoking. This is because when a person smokes, carcinogens such as Polycyclic Aromatic Hydrocarbons are absorbed into the bloodstream and circulated throughout the body, including the ovaries. These toxic substances can trigger or cause mutations in the ovarian epithelial cells (Epithelium), especially in cells that have the potential to develop into mucus-producing cells, causing them to divide abnormally and eventually form tumors.
Quitting smoking not only helps reduce ovarian cancer risk factors, but also lowers the risk of many other types of cancer throughout the body.
5. Hormone Replacement Therapy - HRT
Postmenopausal women who receive estrogen-only hormone replacement therapy (without progesterone), or who use it continuously for a long period of time (such as more than 5-10 years), may have a slightly increased level of ovarian cancer risk factors. If hormone therapy is necessary to relieve menopausal symptoms, it should be used at the lowest effective dose and for the shortest possible duration under close medical supervision.
6. Pregnancy & Breastfeeding
Full-term pregnancy and breastfeeding can help reduce ovarian cancer risk factors because they are natural periods when ovulation stops and the ovaries are able to rest. The longer a woman breastfeeds, the more the risk may decrease.
Although pregnancy and having children may not fit the lifestyle of every modern family and are not always easy choices, this information can help women without children better understand that they may have higher ovarian cancer risk factors and plan more careful health screening and follow-up accordingly.
When ovarian cancer risk factors are present, early detection is essential
Ovarian Cancer Screening
The recommended approach for effective screening, if the goal is to detect disease at Stage 1 in people with elevated ovarian cancer risk factors, is to use this 3-part combination recommended by doctors:
- Pelvic examination
- Transvaginal ultrasound to assess the physical appearance of the ovaries and check for abnormal masses or cysts
- CA-125 blood test to measure the level of a protein that may indicate ovarian cancer
Frequently Asked Questions
Q: Who is at the highest risk of ovarian cancer?
A: People with BRCA gene mutations, those with first-degree relatives who have ovarian cancer, and women aged 50 and older are at the highest risk.
Q: What can BRCA genetic testing tell you?
A: It shows your future risk level. It does not mean you already have cancer.
Q: Is it true that never having children increases the risk?
A: It is associated with repeated ovulation over a long period of time, which may increase the risk
Q: What tests should be done for monitoring?
A: Pelvic examination, transvaginal ultrasound, and a CA-125 blood test, as recommended by your doctor.
Article by
Kunthida Rithirangsriroj, M.D.
Women Health Centre
Specialty
Obstetrics and Gynaecology , Gynaecological Oncology
Language
Thai, English
– 2012 Thai Board of Obstetrics and Gynaecology, Chulalongkorn University
– 2014 Thai Subboard of Gynaecological Oncology
– Obstetrics and Gynaecology
– Gynecologic Oncology
– General OB/Gyne
– Colposcopy
– Minimally invasive surgery
– Women health screening : cervical cancer screening, transvaginal ultrasound, breast cancer screening
– 2006 Doctor of Medicine, Chulalongkorn University
– 2012 Thai Board of Obstetrics and Gynaecology, Chulalongkorn University
– 2014 Thai Subboard of Gynaecological Oncology
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