Growing Attention, Yet Still a Dangerous Cancer
In the United States, public figures and campaigners have raised awareness about ovarian cancer, spotlighting its impact as a deadly disease. Ovarian cancer is known by the frightening nickname “Silent Killer” because its early symptoms are often vague and easily mistaken for common ailments, leading to late-stage diagnoses.
According to projected 2025 statistics, approximately 20,890 women in the U.S. are expected to be newly diagnosed with ovarian cancer, with about 12,730 predicted to die from the disease. Among gynecological cancers, it has one of the lowest survival rates, making it particularly lethal. Recently, there has been a concerning increase in ovarian cancer cases among younger women in their 20s and 30s, associated with factors such as early menarche and delayed age at first childbirth, which increase lifetime ovulations and raise significant public health concerns.
This is why ovarian cancer is often called the “Silent Killer.”
Virtually Absent or Vague Symptoms in Early Stages
The main reason ovarian cancer is called the “Silent Killer” is because there are virtually no noticeable symptoms in the early stages. The ovaries are small organs about the size of a thumb located deep in a woman’s pelvis, and there are often no symptoms at all until the cancer progresses to stages 3-4.
Ovarian cancer symptoms are very common and non-specific, as follows. Research shows that over 70% of ovarian cancers show no symptoms in early stages, and even when symptoms appear, they are non-specific and easily mistaken for other conditions.
- Persistent abdominal bloating and fullness
- Early satiety
- Pelvic pain or discomfort
- Frequent urination or urgency
These symptoms are easily confused with other common conditions such as gastrointestinal disorders, menstrual cramps, or bladder infections, making early detection difficult. In fact, a large-scale study showed that 72% of patients with high-risk early ovarian cancer exhibited one or more symptoms, but even the most common symptoms were only abdominal and pelvic pain (31%) and abdominal bloating (26%). These vague symptoms are a major cause of patients delaying hospital visits. However, the importance of taking these symptoms seriously is highlighted by research showing that while 95% of ovarian cancer patients experienced symptoms before diagnosis, patients who ignored their symptoms had a significantly higher probability of being diagnosed at advanced stages compared to those who didn’t. Although 95% of ovarian cancer patients experienced symptoms for 3-12 months before diagnosis, these common symptoms are easily dismissed. If symptoms persist for more than 3 weeks and are new or frequently recurring, you must consult a specialist. Paying attention to changes in your body is key to early detection.
Absence of Early Screening Tests and Diagnostic Delays
Another reason for delayed ovarian cancer diagnosis is the lack of established early screening tests. While cervical cancer can be detected early through regular Pap smears, no effective screening method has yet been developed for ovarian cancer.
The tumor marker CA-125 and ultrasound examinations are sometimes performed in gynecological health screenings. CA-125 is a protein that can be produced by ovarian cancer cells, with levels below 35 U/mL generally considered normal. However, this test has limitations for use as an ovarian cancer screening tool:
- 5% of healthy women also show levels above 35 U/mL
- It can be elevated in benign conditions such as endometriosis, uterine fibroids, and pregnancy
- 25% of early ovarian cancer patients show normal levels
While transvaginal ultrasound allows more detailed visualization of the ovaries, it also cannot definitively diagnose cancer.
Therefore, according to the results of a large-scale 20-year study in the UK (UKCTOCS), ovarian cancer screening using CA-125 testing and ultrasound was found not to improve survival rates. Results showed it only increased unnecessary surgeries and worry.
Due to this lack of effective screening tests, patients who have been receiving regular, consistent check-ups are occasionally diagnosed with stage 3-4 ovarian cancer. Ovarian cancer has the characteristic of developing in a short time and progressing very rapidly to advanced stages, so it is often diagnosed at a late stage when discovered.
Delayed ovarian cancer diagnosis is also problematic. When patients visit with symptoms, diagnosis is delayed if they do not receive pelvic examination and ultrasound or CT scans. Research on treatment delays confirmed that delays of more than one month after diagnosis significantly reduce both overall survival and cancer-specific survival rates. Particularly, patients with delayed treatment had a higher probability of being discovered at advanced stages, and patient psychological distress also increased.
High Mortality and Recurrence Rates
In the United States, about 55% of ovarian cancer patients are diagnosed when the disease has already spread to distant sites (equivalent to stage 3 or higher), causing cure rates to drop significantly—from around 92% with early detection to just 32% for advanced cases. Ovarian cancer survival differs dramatically depending on the stage at diagnosis: the 5-year relative survival rate is 91.7% for localized disease (stage 1), 70.7% for regional spread (stage 2), but falls sharply to 31.8% for distant disease (stage 3 or higher). The overall 5-year relative survival rate for ovarian cancer in the U.S. is approximately 51.6%, which is much lower compared to 91% for breast cancer and around 67% for cervical cancer.
Latest Treatments and Hope
Due to these high mortality and recurrence rates, ovarian cancer still qualifies as a difficult-to-treat cancer, but fortunately, the situation is changing as various treatments have been developed recently.
The anti-VEGF angiogenesis inhibitor bevacizumab, developed in the early 2010s, showed effects in reducing recurrence risk by approximately 30% by inhibiting tumor blood vessel formation. Subsequently, PARP inhibitors emerged, marking a major turning point in ovarian cancer treatment.
PARP inhibitors are drugs that induce cancer cell death by blocking the PARP enzyme that repairs damaged DNA. When used as maintenance therapy after surgery and standard chemotherapy, they have been confirmed to significantly improve progression-free survival (and in the case of Lynparza, overall survival as well). Particularly, with the ability to identify more patients eligible for targeted therapy through homologous recombination deficiency (HRD) testing, more advanced ovarian cancer patients can now benefit from targeted treatment.
Recently, antibody-drug conjugates (ADC) are also rapidly emerging as new ovarian cancer treatments. This approach attaches chemotherapy drugs to antibodies to seek out and attack cancer cells autonomously, offering an alternative for patients experiencing resistance to platinum-based chemotherapy.
High-Risk Groups for Ovarian Cancer
While ovarian cancer occurs most frequently in ages 50-60, the age of onset has recently been decreasing, with many cases occurring in the 40s. Particularly, patients in their 30s show the fastest rate of increase, requiring caution even among younger women.
Risk is higher in the following cases:
- Women with no pregnancy or childbirth experience
- Women with early menarche
- Women with late childbirth
- Women who have had breast cancer
- Women with family members who have had ovarian, breast, or colorectal cancer
Importance of Genetic Factors
About 10-15% of ovarian cancer is hereditary. Particularly, the gene made well-known by Hollywood actress Angelina Jolie—women with BRCA1 or BRCA2 gene mutations have increased risk of developing ovarian cancer:
- BRCA1 mutation: 39-58% ovarian cancer risk
- BRCA2 mutation: 13-29% ovarian cancer risk
These are very high figures compared to the general female population’s ovarian cancer risk of about 1.1%. The probability of inheriting a BRCA gene mutation from mother or father is 50%.
Specific Methods for Ovarian Cancer Prevention
Oral Contraceptive Use
Taking oral contraceptives for 5 years or more can reduce ovarian cancer risk by 30-50%, and this effect persists for decades after use. The preventive effect is clear even for BRCA gene mutation carriers, making it a recommended strategy. However, individual consultation is needed for those with breast cancer.
Childbirth and Breastfeeding
Women with more pregnancies and first childbirth before age 26 have lower ovarian cancer risk. Ovulation suppression during pregnancy and breastfeeding contributes to risk reduction.
Lifestyle Management
- Obesity and smoking increase ovarian cancer risk, so regular exercise and smoking cessation are necessary (smoking has been reported to increase the risk of mucinous ovarian cancer).
- Maintain healthy weight and pay attention to reducing abdominal fat.
Special Management for High-Risk Groups
- Regularly undergo CA-125 blood tests and transvaginal ultrasound examinations and consult with medical professionals.
- If there is family history, especially if a first-degree relative has ovarian cancer, the incidence rate increases 3-6 times, so actively pursuing genetic testing is advisable.
- High-risk groups with BRCA and other gene mutations should consider risk-reducing salpingo-oophorectomy (RRSO) at an appropriate time after genetic counseling, and must decide after medical consultation. BRCA1 carriers are recommended for preventive surgery at ages 35-40, and BRCA2 carriers at ages 40-45, with completion of childbearing before these ages recommended. Hormone replacement therapy may be needed after surgery.
Currently, there is no method to completely prevent ovarian cancer, but occurrence can be reduced through high-risk group management. Particularly for high-risk women with BRCA gene mutations, preventive removal of ovaries and fallopian tubes after completing childbearing plans can prevent up to 99% of cases. To detect ovarian cancer early, it’s recommended to set a specific date each year that can be remembered like a “birthday” for regular gynecological check-ups.
Monitoring Your Body is the Best Prevention and Treatment
Ovarian cancer is called the “Silent Killer” because early symptoms are difficult to notice and hard to distinguish from common symptoms. Most importantly, raising awareness about ovarian cancer and not missing opportunities for early detection through regular check-ups is crucial. If you’re in a high-risk group, you should consider regular check-ups, genetic testing, and when necessary, preventive surgery. Even for average women, the fact that risk can be reduced through lifestyle improvements such as oral contraceptive use, childbirth, breastfeeding, exercise, and smoking cessation is important.
Ovarian cancer is no longer a “death sentence.” It is a disease where the will to overcome through treatment, with medical professionals, patients, and families working as one team, is most important, and through which positive outcomes can be expected.
