Ovarian, Fallopian Tube, and Peritoneal Cancer: Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 09/2021

ON THIS PAGE: You will find out more about the factors that increase the chance of developing ovarian, fallopian tube, and peritoneal cancer. Use the menu to see other pages.

A risk factor is anything that increases a person's chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person's risk of developing ovarian/fallopian tube cancer.

  • Family history. A strong family history of breast or ovarian/fallopian tube cancer puts a person at higher risk for ovarian/fallopian tube cancer. Doctors believe this is because many of these families have genetic mutations, or changes in a gene, that are passed from generation to generation (see “Genetics,” below). If you are concerned that ovarian/fallopian tube cancer may run in your family, it is important to get an accurate family history, including any breast cancers in the family. A family history of certain other types of cancer, including breast cancer, can be linked to an increased risk of ovarian/fallopian tube cancer. By understanding your family history, you and your doctor can talk about ways to reduce your risk and be proactive about your health.

  • Genetics. About 10% to 20% of ovarian/fallopian tube cancers occur because a genetic mutation has been passed down within a family. This inherited risk is called a germline mutation. The American Society of Clinical Oncology (ASCO) recommends that all people diagnosed with epithelial carcinoma, which is the most common type of ovarian/fallopian tube cancer, receive genetic testing at the time of diagnosis for several cancer risk genes, including BRCA1 and BRCA2, RAD51, and PALB. This testing should be done regardless of whether there is a family history of ovarian or breast cancer. People with ovarian/fallopian tube cancer who do not have an inherited genetic mutation should also be tested for BRCA mutations in the tumor cells, called somatic testing (see “Biomarker testing of the tumor” in Diagnosis), as treatments for ovarian cancer with these mutations are effective regardless of whether the mutation is inherited or whether the mutation arises only in the tumor itself.

    A mutation in the BRCA1 or BRCA2 gene is associated with an increased risk of developing these cancers. Someone with an "average risk" has about a 1% to 2% lifetime risk of developing ovarian/fallopian tube cancer. Having a BRCA1 mutation means there is around a 40% lifetime risk, and having a BRCA2 mutation means the lifetime risk is at about 10% to 20%. BRCA-related ovarian/fallopian tube cancers can occur even when there is not a family history of either breast or ovarian/fallopian tube cancer. About 40% of people with ovarian/fallopian tube cancer who are found to have a BRCA mutation do not have a family history of ovarian or breast cancer. Healthy first-degree and second-degree relatives of a person with ovarian/fallopian tube cancer with a BRCA mutation should also be tested for a mutation, because the risk of cancer can be inherited. Read more about the BRCA1 and BRCA2 genes in this website’s section on hereditary breast and ovarian cancer.

    A genetic counselor can help you and/or your family members understand the results of genetic testing. The results of this testing can help determine your treatment options.

    This information is based on ASCO recommendations for Germline and Somatic Tumor Testing in Epithelial Ovarian Cancer. Please note that this link takes you to a separate ASCO website.

  • Genetic conditions. There are several genetic conditions that can cause ovarian/fallopian tube cancer, including:

    • Lynch syndrome. Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, increases a person's risk of ovarian/fallopian tube cancer and uterine cancer. It is caused by mutations in several different genes. Lynch syndrome also increases the risk of colorectal cancer and several other cancers.

    • Peutz-Jeghers syndrome (PJS). PJS is caused by a specific genetic mutation. The syndrome is associated with multiple polyps in the digestive tract that become noncancerous tumors and with increased pigmentation (dark spots on the skin) on the face and hands. PJS raises the risk of ovarian/fallopian tube cancer, breast cancer, colorectal cancer, cervical cancer, and several other types of cancer.

    • Nevoid basal cell carcinoma syndrome (NBCCS). People with NBCCS, also called Gorlin syndrome, have an increased risk of developing fibromas. Fibromas are benign fibrous tumors of the ovaries. There is a small risk that these fibromas could develop into a type of ovarian cancer called fibrosarcoma. People with NBCCS often have multiple basal cell skin cancers and jaw cysts and may develop medulloblastoma, a type of brain tumor, in childhood.

    • Li-Fraumeni syndrome and ataxia-telangiectasia. People with Li-Fraumeni syndrome or ataxia-telangiectasia may have a slightly increased risk of developing ovarian cancer.

    There may be other hereditary syndromes linked to these types of cancer, including small-cell carcinoma with an inherited SMARCA4 mutation and Sertoli-Leydig cell tumors with DICER1 syndrome. Research in this area is ongoing. Only genetic testing can determine whether a person has a genetic mutation. Most experts strongly recommend that people who are considering genetic testing first talk with a genetic counselor. This expert is specially trained and can explain the risks and benefits of genetic testing and can help interpret the results.

  • Age. The risk of developing ovarian/fallopian tube cancer increases with age. While a diagnosis can happen at any age, those over age 50 are more likely to develop these cancers. About half of those diagnosed with ovarian/fallopian tube cancer are 63 years old or older.

  • Weight. Recent studies show that people who were obese in early adulthood, but not those who gain weight later in life, may have an increased risk of developing ovarian/fallopian tube cancer. People who are obese are more likely to die from any condition, including ovarian/fallopian tube cancer.

  • Endometriosis. When the inside lining of the uterus grows outside of the uterus, affecting other nearby organs, it is called endometriosis. This condition can cause several problems, but effective treatment is available. Researchers are continuing to study whether endometriosis is a risk factor for ovarian cancer. It may increase the risk of certain types of ovarian cancer, including clear cell and endometrioid ovarian cancers.

  • Ethnicity. People of North American, Northern European, or Ashkenazi Jewish heritage have an increased risk of ovarian cancer. People of some of these ethnicities also have higher risks of BRCA mutations.

  • Reproductive history. A person may have an increased risk of ovarian/fallopian tube cancer if they:

    • Started their menstrual periods much earlier than the average age of about 12

    • Have never given birth to a child

    • Have unexplained infertility (the medical inability to have a child)

    • Have not taken birth control pills

    • Entered menopause much later than the average age of 51

  • Hormone replacement therapy. People who have taken estrogen-only hormone replacement therapy (HRT) after menopause may have a higher risk of ovarian/fallopian tube cancer. The risk becomes higher the longer the therapy is used. The risk decreases over time after the therapy ends.

Fertility drugs were once thought to increase the risk of ovarian/fallopian tube cancer. It has been shown that they do not increase the risk.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause ovarian/fallopian tube cancer, including ways to prevent it. Although there is no proven way to completely prevent ovarian/fallopian tube cancer, you may be able to lower your risk. Talk with your health care team for more information about your personal risk of cancer.

Research has shown that certain factors may reduce the risk of developing ovarian/fallopian tube cancer:

  • Taking birth control pills. People who took oral contraceptives for 3 or more years are 30% to 50% less likely to develop ovarian/fallopian tube cancer. The decrease in risk may last for 30 years after they stop taking the pills. Intrauterine devices (IUDs) have also been linked to a decreased risk in ovarian cancer.

  • Breastfeeding. The longer someone breastfeeds after giving birth, the lower their risk of developing ovarian/fallopian tube cancer.

  • Pregnancy. The more full-term pregnancies a person has had, the lower their risk of ovarian/fallopian tube cancer.

  • Surgical procedures. People who have had a hysterectomy or a tubal ligation may have a lower risk of developing ovarian/fallopian tube cancer. A hysterectomy is the removal of the uterus and, sometimes, the cervix. Tubal ligation is having the fallopian tubes “tied” or closed surgically to prevent pregnancy. Doctors recommend a bilateral salpingo-oophorectomy, which is the removal of both ovaries and fallopian tubes, for people with a high risk of ovarian/fallopian tube cancer. After giving birth to all of the children they intend to have, a person may choose to have their fallopian tubes removed at the time of abdominal surgery for other purposes or during a caesarean section, also called a C-section.

    For people with high-risk genetic mutations, such as BRCA1, BRCA2, and the genes related to Lynch syndrome, having the ovaries and fallopian tubes removed after having children is recommended to prevent ovarian/fallopian tube cancers as well as possibly reduce the risk of breast cancer. This can reduce ovarian/fallopian tube cancer risk by as much as 96%. If performed before menopause occurs naturally, there may be a 40% to 70% reduction in the risk of developing breast cancer, particularly in people with BRCA2 mutations.

    It is very important that, when considering preventive surgery, you talk with your doctors and genetic counselors to understand the risks and side effects of the surgery compared to your personal risk of developing ovarian/fallopian tube cancer without preventive surgery.

The next section in this guide is Symptoms and Signs. It explains what changes or medical problems ovarian, fallopian tube, and peritoneal cancer can cause. Use the menu to choose a different section to read in this guide.