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Global patterns and temporal trends in ovarian cancer morbidity, mortality, and burden from 1990 to 2019

  • Afrooz Mazidimoradi ORCID logo , Zohre Momenimovahed ORCID logo , Yousef Khani ORCID logo , Armin Rezaei Shahrabi ORCID logo , Leila Allahqoli ORCID logo and Hamid Salehiniya ORCID logo EMAIL logo
Published/Copyright: November 13, 2023
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Oncologie
From the journal Oncologie Volume 25 Issue 6

Abstract

Objectives

Ovarian cancer (OC) is the deadliest gynecological cancer in the world. Deeper knowledge over time is the basis for global studies to design and implement effective measures to reduce inequalities; this study was conducted to investigate the trend of OC incidence and management in the world from 1990 to 2019.

Methods

We obtained crude numbers and age-standardized rate (ASRs) of OC annually from the 2019 Global Burden of Disease (GBD) study to examine OC’s morbidity, mortality rates, and disability-adjusted life years (DALYs) based on age group, sociodemographic index (SDI), WHO regions, continents, World Bank regions, and GBD regions from 1990 to 2019 in 204 countries and territories. The relative change (%) and average Annual Percent Change (AAPC) were used to display the epidemiological trend.

Results

Globally, the number of OC incidents increased from 141,706 in 1990 to 294,422 in 2019. Despite the age-standardized incidence rate (ASIR) in regions with high SDI having a downward trend, these areas recorded the highest incidence cases and ASIR in 2019. Although the World Bank high-income level had the most frequent incidence cases and ASIR, the ASIR in these regions decreased from 1990 to 2019. Among the continents, Europe and America have the highest ASIR but experienced a decreasing trend from 1990 until 2019 in ASIR. The age-standardized mortality rate (ASMR) in the World Bank high-income level experienced a decreasing trend in 1990–2019. In contrast, in the middle, low-middle, and low SDI regions, the death number increased approximately 3.5–4.1 times, and the ASMR had a significant increase from 0.5 in the middle to 0.75 in the low-middle SDI. Globally, the DALY cases of OC rose from 2,732,666 in 1990 to 5,359,737 in 2019; almost doubling. A significant decrease in the DALYs ASR was observed in seven GBD regions. The most pronounced decrease was found in Australia.

Conclusions

The trend of OC incidence and burden and approximate mortality were stable from 1990 to 2019; especially in lower socioeconomic areas and low-income countries; while the incidence ASR of this cancer in the high SDI regions decreased from 1990 to 2019. The key to reducing OC remains in primary prevention. Approaches such as weight loss, a healthy lifestyle and diet, promoting childbearing and breastfeeding, and recommending the use of oral contraceptives in eligible individuals can have a protective effect against this silent killer.

Keywords: burden; incidence; mortality; trend; ovarian cancer

Introduction

Cancer is one of the main causes of mortality and morbidity around the world, and its global burden is increasing [1]. Ovarian cancer (OC) as one of the most common gynecological cancers in the world is the deadliest gynecological cancer, which has a considerable incidence variety in the world [2]. 90 % of cases of this cancer are epithelial type, which is classified into two categories mucinous and non-mucinous cancers [3]. Mucinous ovarian cancer, which results from pre-malignant diseases, is rare. Non-mucinous epithelial ovarian cancer is classified as serious, endometriosis, and clear and burner cells. Non-epithelial cancers are less invasive than epithelial cancers [1].

Although the incidence and mortality of OC are lower than some cancers, it is known as one of the challenges of the health system; the lack of specific symptoms or effective screening approaches has led to more than 70 % of patients being diagnosed with advanced stages [4]. Therefore, this neoplasm is associated with a weaker prognosis and higher mortality [5]. Early detection of early-stage OC (stages 1A and 1B) has a better prognosis and is associated with a five-year survival rate of 92 %. However, only 15 % of patients with OC are diagnosed at an early stage [6]. Different risk factors affect the development of OC. Genetic factors and breast cancer gene (BRCA) mutations are the most common risk factors. Also, reproductive and lifestyle factors increase the susceptibility to this cancer. Pregnancy, breastfeeding, and oral contraceptive pills are among the protective factors against OC. Also, one of the influencing factors on OC statistics is the economic and social indicators of countries [7]. Growing statistics of OC over the years show changes in risk factors, which are involved in the occurrence of this disease [8]. Knowing the incidence and mortality trend of this cancer as well as its diversity in terms of geography and the level of social development and income of countries, are the basis for global studies to reduce existing inequalities and change the relevant statistics [9, 10], this study was conducted to investigate the trend of incidence, mortality, and burden of OC; and comparing these indicators based on different classifications including different age group, SDI, WHO regions, continents, World Bank regions and GBD regions.

Materials and methods

Data source

Annual data on OC’s incidence, mortality, and DALYs from 1990 to 2019, and the relative changes (%) of the mentioned indicators were obtained from the GBD study in 2019 which is available at http://ghdx.healthdata.org/gbd-resultstool. In GBD, cancers data has been presented according to the International Classification of Diseases 10 (ICD-10) (C56.9 for OC) and in the form of number and ASR. 286 causes of death, 369 cause of non-fatal burden, and 87 risk factors were included in the GBD 2019 estimations. Full time-series estimates were given by GBD 2019 for 204 countries and territories from 1990 to 2019 [11]. To provide a complete view of data interpretation, the study was conducted using various classifications. The geometric mean of lag-distributed income per capita, average educational attainment for people aged≥15 years, and the total fertility rate in people aged <25 years was known as SDI. All countries and territories were assigned to five SDI classes: low, low-middle, middle, high-middle, and high SDI [11, 12]. World Bank divided countries into four groups: low income, lower-middle income, upper-middle income, and high-income. Smoothing out of the exchange rate fluctuations is calculated based on Gross National Income (GNI) per capita (U.S. dollars) [13].

Consent was not necessary for this study because it utilized online data. The relevant guidelines and regulations were followed in performing all procedures, and there was no publication of identifying information.

Statistical analysis

Values with a 95 % uncertainty interval (UI) were used to express the data. For each classification, to eliminate the influence of age group composition and ensure statistical indicators were comparable, the ASRs of OC epidemiological indicators based on 100,000 populations were employed. The study term definitions are accessible at https://www.healthdata.org/terms-defined and https://www.healthdata.org/gbd/. We used relative changes (%) between years to show the comparative changes of ASRs in incidences, deaths, and DALY. To determine the relative difference, we divide the absolute difference in the value of the original year and multiply it by 100 [14].

Epidemiological trends of OC indices were determined by calculating AAPC and its 95 % UI for 30 years and using Joinpoint regression analysis by Joinpoint regression software 4.9. 1.0. AAPC and the lower limit of 95 % UI above zero indicate the upward trend of the index. AAPC and the upper limit of 95 % UI less than 0 indicate a downward trend. Other values indicate the stability of the index during the time under review [15].

Results

Ovarian cancer incidence rate and its temporal trends from 1990 to 2019

The incidence number of OC worldwide increased by over two-fold from 141,706 in 1990–294,422 in 2019. During the same period, the ASIR of OC increased from 6.46 per 100,000 in 1990 to 6.87 per 100,000 in 2019 (ASIR increase=+0.06, 95 % UI: −0.10 to +0.20; AAPC=0.23, 95 % UI: 0.20 to 0.25). Also, 72.3 % of the total incidence of OC occurred among people aged above 50 years, of which more than 46 % occurred among women aged 50–69 years.

The highest incidence rate and ASIR have been reported in high SDI regions, but the ASIR in these regions had decreased from 1990 to 2019 (−0.14 decrease; AAPC=−0.71, 95 % UI: −0.78 to −0.66). In contrast, in other regions, the incidence rate of this cancer increased from approximately 1.8 times in high-middle SDI to 4.3 times in low-middle SDI regions, and its ASIR experienced a significant increase from 0.03 in high-middle SDI to 0.91 in the low-middle SDI regions (Figure 1).

Figure 1: Ovarian cancer incidence (ASR per 100,000) trend by (A) SDI, (B) continents, and (C) WHO regions, 1990–2019.
Figure 1:

Ovarian cancer incidence (ASR per 100,000) trend by (A) SDI, (B) continents, and (C) WHO regions, 1990–2019.

Meanwhile, the highest incidence cases and ASIR of OC were observed in the World Bank high-income regions, and the ASIR in these regions decreased from 1990 until 2019 (−0.12 decrease). In contrast, in the low, lower-middle, and upper-middle-income regions, the incidence rate of this cancer increased by approximately 2.5–3.7 times, and its ASIR increased from 0.29 in upper-middle to 0.65 in lower-middle-income regions.

Among the continents, Europe and then America had the highest ASIR, but they experienced a decreasing trend from 1990 until 2019 in ASIR, while Africa and Asia observed a significant increase in the incidence rate and ASIR of this cancer; AAPC=1.70, 95 % UI: 1.69 to 1.72 and AAPC=1.65, 95 % UI: 1.63 to 1.67, respectively (Figure 1).

Between the WHO regions, the highest incidence rate and ASIR observed in Europe, and then in the American and Eastern Mediterranean regions, but only European and American regions experienced a decline in ASIR from 1990 until 2019. Other regions however recorded a significant increase in ASIR from 0.50 (Western Pacific region) to 1.12 (Eastern Mediterranean region) (Figure 1).

Of various GBD regions, 18 regions experienced a significant increase in the OC morbidity rate from 1990 until 2019, but the greatest increase was detected in the Caribbean (increase in ASIR=1.89, 95 % UI: 0.38–2.64). A significant decrease in the ASIR was observed in three GBD regions of Australia (−0.24, 95 % UI: −0.41 to +0.03), high-income North America (−0.22, 95 % UI: −0.37 to −0.02) and Western Europe (−0.20, 95 % UI: −0.31 to +0.02).

In 2019, the highest ASIR of OC was reported in Monaco (22.75), Brunei Darussalam (16.12), Pakistan (15.85), Seychelles (15.66), American Samoa (15.60), United States Virgin Islands (14.13), Greenland (13.57), United Kingdom (13.22), Samoa (13.12) and Ireland (12.84). From 1990 until 2019, 171/204 countries and territories recorded an increase and 33/204 reported a decrease in the ASIR of OC. Trinidad, Tobago (4.28, 95 % UI: 0.31–6.73) and Barbados (3.86, 95 % UI: 0.29–5.43) recorded the highest rise in OC; and the highest ASIR fall was also reported in Austria (−0.36, 95 % UI: −0.50 to −0.19) and Belgium (−0.35, 95 % UI: −0.51 to −0.04) from 1990 until 2019 (Table 1).

Table 1:

Ovarian cancer incidence rates in 2019 and its trends, 1990–2019, by age, SDI region, World Bank income level, continents, WHO regions, and GBD region.

1990 2010 2019 1990–2010 2010–2019 1990–2019
Incidence numbers (95 % UI) Incidence ASR per 100,000 (95 % UI) Incidence numbers (95 % UI) Incidence ASR per 100,000 (95 % UI) Incidence numbers (95 % UI) Incidence ASR per 100,000 (95 % UI) ASR changes (95 % UI) ASR changes (95 % UI) ASR changes (95 % UI)
Global 141,706 6.46 229,929 6.64 294,422 6.87 0.03 0.03 0.06
(130,541_160,779) (5.97_7.29) (214,203_247,838) (6.18_7.14) (260,649_329,727) (6.08_7.7) (−0.05_0.11) (−0.06_0.13) (−0.1_0.2)
Age
10 to 24 5,808 8,557 9,791
(4,589_7,648) (7,569_9,582) (8,157_11,315)
25 to 49 34,935 59,736 71,404
(30,454_42,222) (54,562_65,603) (61,669_81,455)
50–69 years 65,290 100,307 135,107
(60,965_73,424) (94,582_107,912) (118,168_151,221)
70+ years 35,083 60,509 77,131
(32,165_37,477) (53,971_65,046) (66,946_85,958)
SDI
High SDI 62,463 11.46 74,193 9.90 80,454 9.30 −0.14 −0.06 −0.19
(56,715_64,466) (10.4_11.8) (69,336_77,405) (9.4_10.31) (70,504_91,461) (8.23_10.56) (−0.17_0) (−0.15_0.04) (−0.29_−0.04)
High-middle SDI 43,567 7.31 66,408 7.66 77,286 7.56 0.05 −0.01 0.03
(40,298_46,702) (6.75_7.84) (61,875_69,950) (7.13_8.07) (65,885_86,459) (6.43_8.45) (−0.03_0.12) (−0.12_0.09) (−0.1_0.16)
Low SDI 4,095 2.96 9,651 4.09 16,389 5.15 0.38 0.26 0.74
(2,808_8,460) (2.04_5.89) (7,746_14,268) (3.26_5.95) (13,486_20,299) (4.28_6.34) (0.01_0.76) (0_0.55) (0.02_1.49)
Low-middle SDI 10,234 2.95 26,984 4.51 43,595 5.65 0.53 0.25 0.91
(8,031_16,701) (2.32_4.68) (23,303_33,045) (3.91_5.48) (35,303_54,683) (4.6_7.08) (0.12_0.91) (0.04_0.44) (0.18_1.57)
Middle SDI 21,289 3.42 52,568 4.93 76,545 5.71 0.44 0.16 0.67
(18,298_27,014) (2.98_4.3) (46,976_60,491) (4.41_5.66) (63,249_88,974) (4.7_6.63) (0.17_0.63) (−0.01_0.3) (0.19_1.01)
World Bank income level
World Bank high income 75,795 11.38 91,235 10.07 98,039 9.50 −0.12 −0.06 −0.17
(69,598_78,068) (10.44_11.71) (85,368_95,050) (9.57_10.47) (86,477_111,022) (8.42_10.77) (−0.15_0.02) (−0.15_0.05) (−0.26_−0.02)
World Bank low income 2,866 3.13 6,045 4.02 9,771 4.88 0.28 0.22 0.56
(1,910_6,317) (2.12_6.64) (4,732_9,523) (3.18_6.17) (7,806_13,296) (3.96_6.58) (−0.08_0.66) (−0.03_0.46) (−0.07_1.33)
World Bank lower middle income 23,005 3.79 54,533 5.21 84,862 6.25 0.37 0.20 0.65
(18,259_32,924) (3.06_5.31) (46,069_65,156) (4.45_6.17) (68,602_103,948) (5.09_7.64) (0.08_0.62) (0_0.36) (0.09_1.08)
World Bank upper middle income 39,981 4.55 77,990 5.51 101,597 5.87 0.21 0.07 0.29
(36,213_45,863) (4.15_5.22) (72,318_85,844) (5.11_6.06) (85,089_116,382) (4.92_6.72) (0.04_0.34) (−0.07_0.22) (0.04_0.52)
Continents
Africa 5,092 3.01 11,947 4.13 19,102 4.88 0.37 0.18 0.62
(3,837_8,796) (2.28_5.02) (10,194_14,841) (3.54_5.06) (16,002_23,327) (4.1_5.91) (−0.01_0.65) (−0.04_0.37) (−0.04_1.17)
America 31,535 9.41 46,337 8.73 54,660 8.42 −0.07 −0.04 −0.11
(29,515_32,547) (8.84_9.71) (44,143_48,085) (8.34_9.05) (48,037_62,718) (7.4_9.68) (−0.11_0.04) (−0.15_0.09) (−0.22_0.04)
Asia 41,888 3.57 98,225 4.93 144,017 5.73 0.38 0.16 0.60
(35,381_56,004) (3.06_4.71) (86,769_112,310) (4.38_5.61) (117,220_168,876) (4.66_6.7) (0.11_0.58) (0_0.31) (0.12_0.95)
Europe 63,074 11.45 73,079 10.91 76,246 10.45 −0.05 −0.04 −0.09
(56,286_65,373) (10.08_11.87) (69,386_75,313) (10.46_11.21) (67,263_86,107) (9.26_11.81) (−0.08_0.09) (−0.14_0.07) (−0.18_0.08)
WHO regions
African region 4,196 3.15 9,478 4.16 15,412 4.94 0.32 0.19 0.57
(3,119_7,269) (2.34_5.29) (7,930_11,932) (3.48_5.16) (12,765_18,662) (4.1_5.9) (−0.04_0.59) (−0.05_0.4) (−0.07_1.14)
Eastern Mediterranean region 3,790 3.69 11,774 6.27 19,838 7.81 0.70 0.25 1.12
(2,938_5,903) (2.83_5.67) (9,426_14,265) (5.11_7.67) (13,825_26,991) (5.56_10.58) (0.07_1.37) (−0.05_0.59) (0.05_2.37)
European region 64,408 11.24 75,234 10.74 79,091 10.29 −0.04 −0.04 −0.08
(57,705_66,790) (9.96_11.66) (71,470_77,512) (10.31_11.03) (69,855_89,199) (9.12_11.62) (−0.08_0.1) (−0.14_0.07) (−0.18_0.08)
Region of the Americas 31,535 9.41 46,337 8.73 54,660 8.42 −0.07 −0.04 −0.11
(29,515_32,547) (8.84_9.71) (44,143_48,085) (8.34_9.05) (48,037_62,718) (7.4_9.68) (−0.11_0.04) (−0.15_0.09) (−0.22_0.04)
South-East Asia region 13,631 3.32 33,921 4.63 53,078 5.60 0.39 0.21 0.68
(10,037_21,482) (2.52_5.11) (28,533_42,976) (3.92_5.78) (42,733_66,649) (4.52_7) (0.06_0.73) (−0.01_0.43) (0.07_1.24)
Western Pacific region 23,884 3.60 52,587 4.82 71,560 5.38 0.34 0.12 0.50
(20,823_29,467) (3.14_4.45) (47,205_59,618) (4.33_5.47) (56,926_84,580) (4.3_6.34) (0.09_0.56) (−0.08_0.32) (0.09_0.85)
GBD region
Andean Latin America 471 3.75 1,502 6.43 2,153 7.05 0.71 0.10 0.88
(378_693) (3.02_5.47) (1,152_1,793) (4.89_7.67) (1,522_2,768) (4.98_9.04) (0.16_1.21) (−0.16_0.39) (0.15_1.68)
Australasia 1,315 10.90 1,690 8.88 1,931 8.24 −0.19 −0.07 −0.24
(1,145_1,386) (9.52_11.5) (1,543_1,882) (8.18_9.98) (1,524_2,472) (6.52_10.64) (−0.26_0.07) (−0.25_0.15) (−0.41_0.03)
Caribbean 287 1.98 1,292 5.71 1,527 5.72 1.88 0.00 1.89
(252_441) (1.74_3.05) (876_1,689) (3.86_7.48) (1,102_2,044) (4.15_7.7) (0.29_2.31) (−0.14_0.17) (0.38_2.64)
Central Asia 1,440 5.04 2,469 6.62 3,187 6.94 0.31 0.05 0.38
(1,217_1,591) (4.25_5.56) (2,352_2,588) (6.3_6.92) (2,759_3,567) (6_7.76) (0.18_0.54) (−0.09_0.17) (0.17_0.65)
Central Europe 8,726 11.21 11,304 12.03 11,713 11.73 0.07 −0.02 0.05
(8,283_9,012) (10.6_11.57) (10,743_11,721) (11.47_12.47) (9,997_13,583) (9.96_13.69) (0.04_0.12) (−0.16_0.13) (−0.1_0.22)
Central Latin America 2,642 4.99 7,157 6.95 9,795 7.46 0.39 0.07 0.50
(2,555_2,752) (4.8_5.28) (6,844_7,428) (6.62_7.22) (8,127_11,851) (6.2_9.03) (0.29_0.45) (−0.09_0.28) (0.24_0.79)
Central Sub-Saharan Africa 320 2.22 641 2.51 1,120 3.20 0.13 0.28 0.44
(186_677) (1.32_4.52) (395_1,308) (1.5_4.97) (728_1,809) (2.1_5.13) (−0.16_0.49) (−0.09_0.75) (−0.09_1.31)
East Asia 13,419 2.61 33,423 3.96 47,852 4.61 0.52 0.16 0.77
(100,00,035_18,334) (2.05_3.6) (28,915_39,677) (3.44_4.69) (35,082_59,600) (3.41_5.74) (0.08_0.95) (−0.13_0.49) (0.09_1.47)
Eastern Europe 15,646 9.90 18,778 11.06 18,954 10.84 0.12 −0.02 0.09
(13,500_16,556) (8.38_10.52) (18,315_19,363) (10.81_11.37) (15,904_22,903) (9.01_13.11) (0.05_0.37) (−0.19_0.16) (−0.07_0.37)
Eastern Sub-Saharan Africa 1,770 3.87 3,734 4.86 6,349 6.00 0.26 0.23 0.55
(1,097_3,939) (2.44_8.28) (2,831_5,128) (3.69_6.6) (5,046_7,696) (4.86_7.18) (−0.21_0.7) (−0.02_0.49) (−0.2_1.38)
High income Asia Pacific 6,620 6.13 10,886 7.12 11,882 6.85 0.16 −0.04 0.12
(6,311_6,965) (5.84_6.43) (9,841_11,528) (6.59_7.47) (9,655_14,073) (5.55_8.16) (0.08_0.23) (−0.19_0.13) (−0.1_0.33)
High-income North America 23,115 12.69 27,191 10.64 29,785 9.85 −0.16 −0.07 −0.22
(21,222_23,959) (11.73_13.12) (25,655_28,646) (10.11_11.24) (24,355_36,248) (7.96_12.05) (−0.2_−0.01) (−0.24_0.12) (−0.37_−0.02)
North Africa and Middle East 3,295 3.33 8,375 4.55 12,877 5.27 0.37 0.16 0.58
(2,361_6,096) (2.42_6) (7,015_9,629) (3.86_5.2) (10,395_15,071) (4.29_6.15) (−0.15_0.75) (−0.03_0.3) (−0.17_1.17)
Oceania 48 2.69 125 3.86 184 4.25 0.43 0.10 0.58
(34_104) (1.92_5.46) (85_259) (2.71_7.65) (121_362) (2.89_8.03) (0.01_0.88) (−0.08_0.3) (0.06_1.25)
South Asia 9,996 3.17 26,862 4.60 45,756 5.91 0.45 0.29 0.86
(7,382_15,060) (2.42_4.63) (22,444_32,080) (3.9_5.51) (34,899_56,554) (4.58_7.29) (0.07_0.87) (0.01_0.56) (0.15_1.59)
Southeast Asia 8,175 4.96 19,909 7.00 28,151 7.98 0.41 0.14 0.61
(6,454_12,130) (4.02_7.19) (16,082_27,292) (5.7_9.57) (21,777_38,998) (6.19_11.04) (0.05_0.65) (−0.06_0.33) (0_1.01)
Southern Latin America 1,968 7.79 3,111 8.60 3,631 8.53 0.10 −0.01 0.09
(1,733_2,328) (6.86_9.21) (2,968_3,288) (8.22_9.08) (2,833_4,644) (6.61_10.9) (−0.06_0.28) (−0.23_0.25) (−0.19_0.49)
Southern Sub-Saharan Africa 817 4.70 1,772 6.33 2,323 6.70 0.35 0.06 0.43
(700_975) (3.97_5.61) (1,491_2,045) (5.33_7.32) (1,903_2,786) (5.5_7.97) (0.12_0.63) (−0.17_0.22) (0.11_0.68)
Tropical Latin America 3,120 5.58 6,338 6.13 8,058 6.13 0.10 0.00 0.10
(2,976_3,245) (5.31_5.79) (6,055_6,576) (5.84_6.36) (7,382_8,806) (5.61_6.7) (0.05_0.15) (−0.09_0.1) (0_0.21)
Western Europe 37,386 12.92 40,495 11.01 42,235 10.38 −0.15 −0.06 −0.20
(33,294_3,8634) (11.42_13.34) (37,688_42,288) (10.45_11.48) (36,189_49,048) (8.98_12.1) (−0.19_0) (−0.17_0.08) (−0.31_−0.02)
Western Sub-Saharan Africa 1,130 2.28 2,874 3.29 4,961 4.06 0.44 0.23 0.78
(841_1,629) (1.7_3.27) (2,240_3,636) (2.56_4.13) (3,595_6,761) (2.87_5.53) (0.03_0.96) (−0.08_0.59) (0.04_1.7)

Ovarian cancer mortality rate and its temporal trends from 1990 to 2019

Globally, the number of OC deaths increased from 97,363 in 1990–198,412 in 2019, which is over a two-fold increase. During the same period, ASMR of OC decreased from 4.59 per 100,000 people in 1990 to 4.56 per 100,000 people in 2019; AAPC=−0.02, 95 % UI: −0.05 to +0.01, but from 2010 to 2019, its trend increased. Nearly 86 % of the total deaths occurred among people aged over 50 years, of which 47.01 % occurred among people aged 50–69 years.

The highest cases of deaths and ASMR were observed in high and high-middle SDI regions, but the ASMR in these regions experienced a decreasing trend from 1990 until 2019 (−0.06; AAPC=−0.19, 95 % UI: −0.12 to +0.13). In contrast, in the middle, low-middle, and low SDI regions, the number of deaths increased approximately by 3.5–4.1 times, and the ASMR experienced a significant increase from 0.5 (AAPC=1.42, 95 % UI: 1.40 to 1.43) in middle to 0.75 (AAPC=1.96, 95 % UI: 1.94 to 1.99) in low-middle SDI regions (Figure 2).

Figure 2: Ovarian cancer death (ASR per 100,000) trend by (A) SDI, (B) continents, and (C) WHO regions, 1990–2019.
Figure 2:

Ovarian cancer death (ASR per 100,000) trend by (A) SDI, (B) continents, and (C) WHO regions, 1990–2019.

Meanwhile, the highest number of deaths and ASMR were observed in the World Bank high-income countries, and the ASMR in these regions experienced a decreasing trend from 1990 until 2019 (−0.21). In contrast, in the low, lower-middle, and upper-middle-income regions, the number of deaths increased approximately by 2.5–3.5 times, and the ASMR experienced a significant increase from 0.15 in upper-middle to 0.53 in lower-middle-income regions.

Among the continents, Europe and then America had the highest ASMR, but they recorded a downward trend in ASMR from 1990 until 2019 (AAPC=−0.51, 95 % UI: −0.43 to −0.35), while the death cases and ASMR in Africa and Asia increased; AAPC=1.53, 95 % UI: 1.51 to 1.55 and AAPC=1.28, 95 % UI: 1.26 to 1.29, respectively (Figure 2).

Among the WHO regions, the highest death cases and ASMR were reported from the European countries, and then in the American and Eastern Mediterranean regions, but only European and American regions experienced a decline in ASMR from 1990 until 2019. Other regions experienced a significant increase in ASMR from 0.31 (Western Pacific) to 0.90 (Eastern Mediterranean) (Figure 2).

Of various GBD regions, 16 regions experienced a significant increase in the OC mortality rate from 1990 until 2019. The greatest increase was detected in the Caribbean (increase in ASMR=1.75, 95 % UI: 0.28–2.45). A significant decrease in the ASMR was observed in five GBD regions, but the most pronounced decrease was observed in Australia (ASMR decrease=−0.27, 95 % UI: −0.37 to −0.21).

In 2019, the highest standardized death rate from OC was reported in Monaco (13.67), Pakistan (11.84), Brunei Darussalam (10.08), and American Samoa (10.00), and also the lowest rate was reported in the Dominican Republic (1.70), Niger (1.72), and Chad (1.83). From 1990 until 2019, a total of 157, 1, and 46 of 204 countries and territories experienced an increased, stable, and decreased ASMR of OC, respectively. Trinidad, Tobago (3.86, 95 % UI: 0.22–5.97), Antigua, and Barbuda (3.78, 95 % UI: 0.43–5.35) recorded the highest rise in OC ASMR. The highest fall in ASMR was also recorded in Iceland (−0.41, 95 % UI: −0.50 to −0.18) and Austria (−0.38, 95 % UI: −0.46 to −0.11) during the study period (Table 2).

Table 2:

Ovarian cancer death rates in 2019 and its trends from 1990 to 2019, by age, SDI region, World Bank income level, continents, WHO regions, and GBD region.

1990 2010 2019 1990–2010 2010–2019 1990–2019
Deaths numbers (95 % UI) Deaths ASR per 100,000 (95 % UI) Deaths numbers (95 % UI) Deaths ASR per 100,000 (95 % UI) Deaths numbers (95 % UI) Deaths ASR per 100,000 (95 % UI) ASR changes (95 % UI) ASR changes (95 % UI) ASR changes (95 % UI)
Global 97,363 4.59 153,456 4.49 198,412 4.56 −0.02 0.01 −0.01
(89,703_109,761) (4.24_5.16) (141,768_164,591) (4.15_4.82) (175,357_217,665) (4.03_5) (−0.09_0.04) (−0.07_0.09) (−0.14_0.1)
Age
10 to 24 1,276 1,626 1,831
(980_1,771) (1,421_1,841) (1,502_2,140)
25 to 49 14,088 22,373 26,265
(12,120_17,527) (20,153_24,800) (22,648_29,966)
50–69 years 47,082 68,952 93,173
(43,811_53,461) (64,241_74,363) (81,327_103,381)
70+ years 34,774 60,333 76,943
(31,793_37,331) (53,535_65,057) (66,525_84,280)
SDI
High SDI 43,458 7.46 50,935 6.05 56,639 5.67 −0.19 −0.06 −0.24
(39,182_45,018) (6.74_7.71) (46,505_53,406) (5.62_6.3) (50,391_61,318) (5.16_6.09) (−0.23_−0.08) (−0.1_−0.02) (−0.3_−0.12)
High-middle SDI 29,784 4.97 44,369 4.98 51,967 4.75 0.00 −0.05 −0.04
(27,764_31,762) (4.63_5.3) (41,253_46,550) (4.62_5.23) (44,998_57,246) (4.11_5.24) (−0.07_0.06) (−0.14_0.04) (−0.16_0.06)
Low SDI 3,065 2.45 6,835 3.26 11,346 4.01 0.33 0.23 0.64
(2,119_6,167) (1.71_4.72) (5,482_9,995) (2.62_4.66) (9,551_13,928) (3.38_4.88) (−0.03_0.69) (−0.01_0.49) (−0.02_1.34)
Low-middle SDI 7,311 2.33 18,541 3.36 29,874 4.09 0.44 0.22 0.75
(5,765_11,582) (1.84_3.6) (16,106_22,445) (2.91_4.07) (24,421_37,624) (3.36_5.15) (0.05_0.79) (0.02_0.4) (0.1_1.34)
Middle SDI 13,706 2.44 32,694 3.27 48,485 3.66 0.34 0.12 0.50
(12,089_17,148) (2.16_3.05) (29,063_37,043) (2.9_3.7) (39,894_56,526) (3.01_4.26) (0.09_0.51) (−0.03_0.25) (0.09_0.79)
World Bank income level
World Bank high income 52,539 7.36 63,052 6.17 69,467 5.79 −0.16 −0.06 −0.21
(48,247_54,310) (6.74_7.59) (57,540_66,058) (5.73_6.43) (61,668_75,181) (5.27_6.23) (−0.2_−0.06) (−0.1_−0.02) (−0.28_−0.1)
World Bank low income 2,087 2.52 4,238 3.15 6,742 3.78 0.25 0.20 0.50
(1,398_4,483) (1.72_5.16) (3,355_6,575) (2.51_4.73) (5,475_8,987) (3.09_4.95) (−0.09_0.59) (−0.03_0.42) (−0.1_1.18)
World Bank lower middle income 15,893 2.87 35,932 3.75 55,844 4.39 0.31 0.17 0.53
(12,898_22,356) (2.38_3.95) (30,940_42,722) (3.25_4.43) (44,897_69,102) (3.56_5.4) (0.03_0.53) (−0.02_0.33) (0.02_0.91)
World Bank upper middle income 26,805 3.22 50,152 3.61 66,258 3.69 0.12 0.02 0.15
(24,591_30,845) (2.95_3.69) (45,886_54,640) (3.3_3.93) (55,420_75,367) (3.09_4.2) (−0.03_0.23) (−0.12_0.17) (−0.08_0.34)
Continents
Africa 3,716 2.43 8,322 3.26 13,042 3.77 0.34 0.16 0.55
(2,830_6,254) (1.86_3.95) (7,084_10,229) (2.78_3.95) (10,957_15,734) (3.18_4.51) (−0.03_0.61) (−0.05_0.33) (−0.07_1.06)
America 21,562 6.40 31,624 5.81 37,960 5.54 −0.09 −0.05 −0.14
(19,964_22,359) (5.96_6.63) (29,509_32,969) (5.46_6.04) (34,793_41,354) (5.1_6.03) (−0.13_0.01) (−0.1_0.01) (−0.2_−0.02)
Asia 27,472 2.55 61,558 3.23 92,385 3.67 0.27 0.14 0.44
(23,711_36,343) (2.2_3.34) (54,176_70,375) (2.84_3.68) (76,661_108,030) (3.05_4.3) (0.02_0.45) (−0.02_0.29) (0.04_0.76)
Europe 44,534 7.51 51,720 6.92 54,747 6.54 −0.08 −0.06 −0.13
(40,617_46,175) (6.79_7.79) (47,975_53,588) (6.53_7.15) (49,071_59,501) (5.86_7.09) (−0.11_0.03) (−0.13_0.01) (−0.2_0)
WHO regions
African region 3,089 2.57 6,718 3.34 10,710 3.89 0.30 0.16 0.51
(2,296_5,235) (1.9_4.21) (5,605_8,445) (2.78_4.15) (8,854_12,748) (3.21_4.6) (−0.05_0.58) (−0.05_0.36) (−0.1_1.04)
Eastern Mediterranean region 2,691 2.90 7,590 4.61 12,381 5.53 0.59 0.20 0.90
(2,069_4,139) (2.19_4.39) (6,147_9,260) (3.78_5.76) (8,675_17,228) (3.91_7.77) (−0.01_1.24) (−0.07_0.5) (−0.05_2.03)
European region 45,432 7.40 53,121 6.86 56,568 6.48 −0.07 −0.05 −0.12
(41,488_47,136) (6.72_7.68) (49,344_54,993) (6.48_7.08) (50,623_61,385) (5.82_7.03) (−0.1_0.03) (−0.13_0.01) (−0.19_0.01)
Region of the Americas 21,562 6.40 31,624 5.81 37,960 5.54 −0.09 −0.05 −0.14
(19,964_22,359) (5.96_6.63) (29,509_32,969) (5.46_6.04) (34,793_41,354) (5.1_6.03) (−0.13_0.01) (−0.1_0.01) (−0.2_−0.02)
South-East Asia region 9,347 2.56 22,445 3.32 35,637 3.94 0.30 0.18 0.54
(7,017_14,370) (1.96_3.81) (19,001_27,685) (2.83_4.07) (28,489_44,890) (3.16_4.94) (0_0.58) (−0.03_0.38) (0.01_1.02)
Western Pacific region 15,051 2.41 31,538 2.90 44,592 3.16 0.20 0.09 0.31
(12,989_19,307) (2.09_3.08) (27,800_35,615) (2.55_3.27) (35,091_52,688) (2.5_3.72) (−0.05_0.41) (−0.1_0.29) (−0.08_0.66)
GBD region
Andean Latin America 320 2.84 971 4.41 1,370 4.63 0.55 0.55 0.63
(258_465) (2.3_4.12) (731_1,167) (3.32_5.32) (968_1,735) (3.28_5.86) (0.02_1) (0.02_1) (0.01_1.28)
Australasia 906 7.20 1,181 5.69 1,384 5.29 −0.21 −0.21 −0.27
(794_955) (6.28_7.58) (1,000,009_1,319) (5.19_6.39) (1,182_1,592) (4.58_6.1) (−0.28_0.04) (−0.28_0.04) (−0.37_−0.01)
Caribbean 191 1.38 861 3.84 1,039 3.81 1.77 1.77 1.75
(167_296) (1.21_2.13) (566_1,120) (2.52_4.99) (734_1,396) (2.7_5.14) (0.2_2.22) (0.2_2.22) (0.28_2.45)
Central Asia 953 3.42 1,601 4.59 2,044 4.68 0.34 0.34 0.37
(803_1,000,006) (2.88_3.78) (1,520_1,679) (4.33_4.82) (1,768_2,287) (4.04_5.22) (0.2_0.58) (0.2_0.58) (0.16_0.63)
Central Europe 6,108 7.52 8,190 7.95 8,650 7.64 0.06 0.06 0.02
(5,834_6,322) (7.17_7.78) (7,717_8,495) (7.53_8.23) (7,446_10,044) (6.57_8.88) (0.02_0.09) (0.02_0.09) (−0.12_0.18)
Central Latin America 1,690 3.63 4,392 4.56 6,141 4.76 0.26 0.26 0.31
(1,626_1,800) (3.47_3.88) (4,164_4,583) (4.31_4.77) (5,096_7,294) (3.95_5.65) (0.17_0.31) (0.17_0.31) (0.08_0.55)
Central Sub-Saharan Africa 242 1.87 470 2.07 800 2.59 0.11 0.11 0.38
(142_501) (1.12_3.68) (281_947) (1.19_3.95) (522_1,299) (1.67_4.11) (−0.16_0.44) (−0.16_0.44) (−0.11_1.18)
East Asia 8,433 1.78 20,280 2.46 30,350 2.79 0.38 0.38 0.57
(6,502_12,138) (1.38_2.59) (17,275_23,727) (2.1_2.88) (22,124_38,066) (2.05_3.49) (−0.04_0.8) (−0.04_0.8) (−0.07_1.25)
Eastern Europe 11,130 6.53 13,179 7.09 13,285 6.74 0.09 0.09 0.03
(9,995_11,728) (5.8_6.9) (12,775_13,787) (6.89_7.39) (11,081_15,918) (5.61_8.05) (0.03_0.3) (0.03_0.3) (−0.12_0.26)
Eastern Sub-Saharan Africa 1,322 3.22 2,704 4.02 4,456 4.83 0.25 0.25 0.50
(829_2,862) (2.04_6.66) (2,054_3,691) (3.04_5.43) (3,629_5,408) (3.95_5.78) (−0.19_0.66) (−0.19_0.66) (−0.2_1.24)
High income Asia Pacific 4,133 3.73 6,383 3.57 7,341 3.45 −0.04 −0.04 −0.07
(3,913_4,418) (3.53_3.99) (5,579_6,820) (3.25_3.76) (6,205_8,064) (3.03_3.72) (−0.12_0.01) (−0.12_0.01) (−0.2_−0.01)
High-income North America 15,850 8.09 19,157 6.87 21,631 6.41 −0.15 −0.15 −0.21
(14,330_16,508) (7.38_8.4) (17,724_20,167) (6.44_7.21) (19,536_23,591) (5.85_6.95) (−0.19_0) (−0.19_0) (−0.27_−0.06)
North Africa and Middle East 2,291 2.56 5,214 3.18 7,825 3.54 0.24 0.24 0.38
(1,661_4,127) (1.86_4.47) (4,444_6,072) (2.75_3.68) (6,488_9,137) (2.93_4.17) (−0.22_0.59) (−0.22_0.59) (−0.25_0.89)
Oceania 31 1.98 75 2.70 110 2.94 0.36 0.36 0.49
(22_64) (1.42_3.85) (52_152) (1.94_5.14) (74_209) (2.05_5.34) (−0.04_0.78) (−0.04_0.78) (−0.01_1.09)
South Asia 7,328 2.60 19,000 3.54 32,100,000 4.40 0.36 0.36 0.69
(5,505_10,799) (2.01_3.76) (16,066_22,804) (3_4.27) (24,894_39,896) (3.39_5.48) (0.01_0.72) (0.01_0.72) (0.05_1.33)
Southeast Asia 5,094 3.45 11,388 4.34 16,187 4.76 0.26 0.26 0.38
(4,100,000_7,253) (2.83_4.83) (9,477_15,742) (3.61_5.96) (12,722_22,681) (3.75_6.64) (−0.04_0.48) (−0.04_0.48) (−0.1_0.72)
Southern Latin America 1,469 5.78 2,219 5.87 2,553 5.64 0.02 0.02 −0.02
(1,289_1,731) (5.08_6.8) (2,096_2,355) (5.57_6.22) (2,344_2,877) (5.19_6.35) (−0.14_0.19) (−0.14_0.19) (−0.21_0.2)
Southern Sub-Saharan Africa 581 3.64 1,293 4.95 1,687 5.14 0.36 0.36 0.41
(488_695) (3.03_4.36) (1,085_1,498) (4.14_5.7) (1,380_2,011) (4.21_6.11) (0.11_0.71) (0.11_0.71) (0.12_0.68)
Tropical Latin America 2,089 4.10 4,203 4.21 5,436 4.09 0.02 0.02 0.00
(1,986_2,177) (3.88_4.29) (3,953_4,374) (3.94_4.38) (4,963_5,914) (3.73_4.45) (−0.02_0.07) (−0.02_0.07) (−0.09_0.09)
Western Europe 26,356 8.21 28,698 6.69 30,612 6.28 −0.18 −0.18 −0.23
(23,607_27,318) (7.33_8.49) (25,841_30,191) (6.2_6.98) (27,024_33,277) (5.7_6.76) (−0.22_−0.07) (−0.22_−0.07) (−0.3_−0.11)
Western Sub-Saharan Africa 849 1.87 1,996 2.62 3,406 3.19 0.41 0.41 0.71
(644_1,214) (1.42_2.66) (1,522_2,466) (2_3.22) (2,427_4,570) (2.24_4.24) (−0.01_0.91) (−0.01_0.91) (0.02_1.53)

Ovarian cancer burden and its temporal trends from 1990 to 2019

Globally, the number of DALYs related to OC increased from 2,732,666 in 1990 to 5,359,737 in 2019, which is almost double in number. During the same period, the age-standardized mortality rate (DALYs ASR) of OC decreased from 124.09 per 100,000 people in 1990 to 124.68 in 2019; AAPC=0.03, 95 % UI: 0.01 to 0.05, but from 2010 to 2019, its trend has increased. Nearly 77 % of the total DALYs occurred among people aged 25–69 years, of which 53 % occurred among people aged 50–69 years.

The highest number of DALYs and DALYs ASR were observed in high and high-middle SDI regions, but the DALYs ASR in these regions experienced a decreasing trend from 1990 until 2019 (−0.28 (AAPC=−1.11, 95 % UI: −1.17 to −1.05) and −0.08 (AAPC=−0.29, 95 % UI: −0.32 to −0.26), respectively). In contrast, in the middle, low-middle, and low SDI regions, the number of DALYs increased by approximately 3.15–3.82 times, and the DALYs ASR increased from 0.44 (AAPC=1.27, 95 % UI: 1.26 to 1.28) in middle to 0.62 (AAPC=1.97, 95 % UI: 1.95 to 1.99) in low-middle SDI regions (Figure 3).

Figure 3: Ovarian cancer DALYs (ASR per 100,000) trend by (A) SDI, (B) continents, and (C) WHO regions, 1990–2019.
Figure 3:

Ovarian cancer DALYs (ASR per 100,000) trend by (A) SDI, (B) continents, and (C) WHO regions, 1990–2019.

Meanwhile, the highest number of DALYs and DALYs ASR reported from the World Bank high-income regions, while the DALYS ASR in these regions decreased from 1990 until 2019 (−0.20). In contrast, in the low, lower-middle, and upper-middle-income regions, the number of DALYs increased by approximately 2.2–3.25 times, and the DALYs ASR increased from 0.09 (upper-middle) to 0.30 (lower-middle-income).

Among the continents, Europe and then America had the highest DALYs ASR, but they experienced a decreasing trend from 1990 until 2019 in DALYs ASR (with AAPC=−0.65, 95 % UI: −0.68 to −0.62 and AAPC=−0.48, 95 % UI: −0.52 to −0.44, respectively), while Africa and Asia observed an increase in the number of DALYs and DALYs ASR during the same period; AAPC=1.45, 95 % UI: 1.43 to 1.47 and AAPC=1.22, 95 % UI: 1.20 to 1.23, respectively (Figure 3).

Among the WHO regions, the most cases of DALYs and DALYs ASR were reported from Europe and then in American and Eastern Mediterranean regions, but European and American regions experienced a decline in DALYs ASR from 1990 until 2019. Meanwhile, DALY ASR in other regions increased from 0.26 (Western Pacific) to 0.91 (Eastern Mediterranean) (Figure 3).

Of various GBD regions, 14 regions experienced a significant increase in the OC mortality rate from 1990 until 2019. The greatest increase was detected in the Caribbean (increase in DALYs ASR=1.68, 95 % UI: 0.28–2.33). A significant decrease in the DALYs ASR was observed in seven GBD regions, but the most pronounced decrease was observed in Australia (decrease in DALYs ASR=−0.33, 95 % UI: −0.43, −0.08).

In 2019, the highest DALYs ASR was reported in Pakistan (348.37), Monaco (342.07), Brunei Darussalam (9,281.99), American Samoa (278.73), Seychelles (263.45), United States Virgin Islands (262.27), Greenland (258.85), Latvia (256.61), Lithuania (255.91) and Guyana (247.63).

From 1990 until 2019, there was an upward trend in 155/204 countries and territories for the DALY ASR of OC and a downward trend in 49/204 others. Trinidad, Tobago (3.81, 95 % UI: 0.21–6.06) and Barbados (3.43, 95 % UI: 0.20–4.86) recorded the highest rise in OC DALYs ASR. The highest fall in OC DALYs ASR was reported in Iceland (−0.42, 95 % UI: −0.52 to −0.20) and Austria (−0.42, 95 % UI: −0.50 to −0.11) (Table 3).

Table 3:

Ovarian cancer DALYs rates in 2019 and its trends from 1990 to 2019, by age, SDI region, World Bank Income Level, continents, WHO regions, and GBD region.

1990 2010 2019 1990–2010 2010–2019 1990–2019
DALYs numbers (95 % UI) DALYs ASR per 100,000 (95 % UI) DALYs numbers (95 % UI) DALYs ASR per 100,000 (95 % UI) DALYs numbers (95 % UI) DALYs ASR per 100,000 (95 % UI) ASR changes (95 % UI) ASR changes (95 % UI) ASR changes (95 % UI)
Global 2,732,666 124.09 4,204,876 121.20 5,359,737 124.68 −0.02 0.03 0.005
(2,493,732_3,165,170) (113.68_142.97) (3,884,973_4,545,902) (112.1_130.93) (4,692,949_5,954,993) (109.13_138.67) (−0.11_0.06) (−0.06_0.11) (−0.15_0.13)
Age
10 to 24 92,036 117,624 132,702
(71,227_127,726) (102,680_133,158) (108,964_154,412)
25 to 49 686,448 1,081,829 1,273,093
(589,210_859,127) (976,777_1,199,098) (1,094,179_1,453,982)
50–69 years 1,420,153 2,112,118 2,823,174
(1,321,775_1,614,600) (1,969,976_2,280,597) (2,459,433_3,132,271)
70+ years 522,102 878,794 1,113,871
(482,096_560,730) (791,905_951,487) (975,511_1,221,853)
SDI
High SDI 1,061,103 198.32 1,146,048 154.61 1,229,123 143.78 −0.22 −0.07 −0.28
(956,786_1,094,307) (178.76_204.3) (1,083,722_1,191,979) (147.46_160.77) (1,125,703_1,323,417) (132.56_154.51) (−0.25_−0.09) (−0.11_−0.02) (−0.33_−0.14)
High-middle SDI 864,811 145.06 1,213,384 139.44 1,378,231 133.03 −0.04 −0.05 −0.08
(793,572_925,109) (132.93_155.31) (1,118,107_1,271,329) (128.49_146.08) (1,191,048_1,526,401) (114.83_147.47) (−0.11_0.02) (−0.14_0.05) (−0.2_0.02)
Low SDI 102,198 71.03 226,586 93.80 373,324 115.17 0.32 0.23 0.62
(69,309_215,443) (48.95_144.88) (181,036_341,988) (75.39_138.52) (311,090_462,226) (96.36_141.83) (−0.05_0.7) (−0.03_0.5) (−0.06_1.34)
Low-middle SDI 241,438 67.61 589,765 97.41 922,653 118.41 0.44 0.22 0.75
(188,017_394,770) (53.25_107.69) (511,642_714,285) (84.63_117.39) (740,013_1,169,375) (95.38_150.23) (0.04_0.79) (0_0.41) (0.07_1.35)
Middle SDI 462,013 73.86 1,026,825 95.49 1,453,634 106.38 0.29 0.11 0.44
(401,880_592,519) (64.7_93.48) (908,838_1,167,372) (84.54_108.74) (1,199,319_1,696,724) (87.67_123.96) (0.04_0.46) (−0.04_0.25) (0.04_0.73)
World Bank income level
World Bank high income 1,297,720 197.98 1,424,225 159.07 1,510,884 148.00 −0.20 −0.07 −0.25
(1,188,195_1,336,622) (180.89_203.66) (1,346,732_1,481,329) (151.76_165.05) (1,390,475_1,628,908) (136.96_159.78) (−0.23_−0.07) (−0.11_−0.02) (−0.31_−0.12)
World Bank low income 69,396 73.55 138,536 90.38 220,627 108.44 0.23 0.20 0.47
(45,830_157,072) (49.12_161.19) (108,481_224,194) (71.31_142.79) (175,376_301,015) (87.23_145.67) (−0.12_0.6) (−0.04_0.44) (−0.14_1.19)
World Bank lower middle income 519,883 83.91 1,152,511 109.01 1,744,032 127.17 0.30 0.17 0.52
(409,803_751,569) (67.42_119.09) (974,866_1,373,121) (92.63_129.99) (1,379,802_2,164,085) (100.99_157.55) (0.01_0.53) (−0.04_0.33) (−0.01_0.91)
World Bank upper middle income 844,559 95.95 1,487,328 104.11 1,881,410 106.39 0.09 0.02 0.11
(766,004_973,776) (87.27_110.23) (1,364,854_1,623,633) (95.53_113.64) (1,573,261_2,142,081) (89.13_120.94) (−0.08_0.19) (−0.12_0.17) (−0.11_0.3)
Continents
Africa 120,777 69.42 268,559 91.09 420,490 100,000.39 0.31 0.16 0.52
(90,758_213,880) (52.57_119.71) (225,685_335,674) (77.2_112.43) (350,218_508,652) (88.59_127.26) (−0.09_0.6) (−0.06_0.34) (−0.14_1.07)
America 557,332 169.11 799,032 151.46 941,223 145.34 −0.10 −0.04 −0.14
(525,694_574,889) (159.88_174.47) (764,464_827,939) (145.21_156.91) (872,363_1,025,609) (135.01_158.52) (−0.14_0) (−0.1_0.02) (−0.21_−0.03)
Asia 899,014 75.45 1,896,381 94.12 2,730,014 107.20 0.25 0.14 0.42
(757,552_1,221,171) (64.57_100.96) (1,659,596_2,165,495) (82.55_107.42) (2,239,232_3,219,963) (88.04_126.71) (−0.01_0.44) (−0.03_0.29) (0_0.74)
Europe 1,153,354 210.57 1,234,907 185.82 1,261,096 173.73 −0.12 −0.07 −0.17
(1,028,824_1,196,292) (185.53_218.74) (1,181,548_1,271,218) (179.09_190.8) (1,133,260_1,374,872) (155.91_189.36) (−0.15_0.01) (−0.14_0) (−0.24_−0.01)
WHO regions
African region 100,089 73.18 216,230 92.92 345,283 108.44 0.27 0.17 0.48
(73,801_178,068) (54.19_127.29) (178,147_278,104) (77.33_117.55) (283,387_419,122) (89.51_130.43) (−0.11_0.56) (−0.06_0.38) (−0.16_1.06)
Eastern Mediterranean region 89,008 84.66 256,591 134.94 417,061 161.78 0.59 0.20 0.91
(68,768_140,518) (65.52_131.93) (200,587_312,820) (108.33_164.47) (283,568_581,659) (111.88_225.03) (−0.01_1.25) (−0.08_0.53) (−0.06_2.03)
European region 1,180,593 207.34 1,278,107 184.10 1,316,591 172.42 −0.11 −0.06 −0.17
(1,000,007,363_1,225,288) (183.74_215.48) (1,224,407_1,315,339) (177.47_189.02) (1,184,739_1,432,571) (154.65_187.99) (−0.14_0.02) (−0.14_0.01) (−0.23_0)
Region of the Americas 557,332 169.11 799,032 151.46 941,223 145.34 −0.10 −0.04 −0.14
(525,694_574,889) (159.88_174.47) (764,464_827,939) (145.21_156.91) (872,363_1,025,609) (135.01_158.52) (−0.14_0) (−0.1_0.02) (−0.21_−0.03)
South-East Asia region 314,061 74.17 709,865 95.46 1,076,925 112.16 0.29 0.17 0.51
(229,448_501,563) (55.35_114.76) (596,376_894,702) (80.42_119.03) (857,775_1,360,596) (89.63_141.58) (−0.02_0.59) (−0.05_0.38) (−0.03_1.01)
Western Pacific region 486,108 72.64 933,763 84.63 1,247,835 91.65 0.17 0.08 0.26
(415,073_610,806) (62.31_91.96) (825,943_100,0,006,185) (74.95_95.53) (992,129_1,478,321) (73.38_108.82) (−0.08_0.37) (−0.11_0.29) (−0.1_0.59)
GBD region
Andean Latin America 10,643 83.91 29,797 128.11 40,930 134.17 0.53 0.05 0.60
(8,517_15,737) (67.22_122.98) (22,658_35,724) (97.4_154.06) (29,298_52,538) (95.92_171.71) (0.04_0.96) (−0.19_0.32) (−0.01_1.27)
Australasia 22,733 191.67 26,369 140.62 29,637 128.09 −0.27 −0.09 −0.33
(19,655_23,917) (165.99_201.8) (24,448_29,628) (130.94_158.27) (25,738_34,301) (111.45_149.4) (−0.33_−0.01) (−0.18_0) (−0.43_−0.08)
Caribbean 5,993 41.57 24,854 110.08 29,259 109.44 1.65 −0.01 1.63
(5,185_9,690) (35.97_66.46) (16,967_34,093) (75.03_150.85) (21,130_40,851) (78.94_153.64) (0.2_2.1) (−0.15_0.16) (0.28_2.33)
Central Asia 30,232 106.38 51,437 137.08 64,750 138.41 0.29 0.01 0.30
(25,688_33,516) (90.39_117.89) (49,176_53,859) (130.78_143.56) (56,175_72,871) (119.88_155.6) (0.16_0.51) (−0.12_0.13) (0.1_0.56)
Central Europe 174,509 223.65 209,266 222.87 210,935 212.29 0.00 −0.05 −0.05
(166,029_180,625) (210.58_231.11) (199,936_216,965) (213.58_230.75) (181,004_245,579) (181.69_247.19) (−0.04_0.04) (−0.17_0.11) (−0.18_0.11)
Central Latin America 55,783 100,000.30 136,526 132.93 183,814 139.44 0.26 0.05 0.32
(54,063_58,415) (101.71_112.14) (130,750_141,854) (127.09_138.16) (152,067_220,400) (115.36_167.07) (0.17_0.31) (−0.11_0.24) (0.09_0.58)
Central Sub-Saharan Africa 8,064 53.09 15,434 58.24 26,272 72.61 0.10 0.25 0.37
(4,673_17,296) (31.29_110.5) (9,550_31,736) (35.2_118.49) (17,015_43,122) (47.24_118.81) (−0.18_0.45) (−0.12_0.72) (−0.14_1.22)
East Asia 288,347 56.07 625,405 73.03 871,645 81.21 0.30 0.11 0.45
(222,940_393,416) (43.42_77.85) (534,488_729,798) (62.49_85.18) (645,106_1,098,317) (60.66_102.31) (−0.07_0.69) (−0.16_0.42) (−0.11_1.06)
Eastern Europe 323,951 202.97 366,777 213.56 360,688 202.71 0.05 −0.05 0.00
(276,933_342,997) (170.92_215.66) (357,760_379,712) (208.46_220.01) (299,272_431,833) (167.41_242.93) (−0.01_0.3) (−0.22_0.12) (−0.16_0.25)
Eastern Sub-Saharan Africa 44,065 92.84 89,367 113.77 147,571 136.91 0.23 0.20 0.47
(27,025_100,756) (57.74_203.8) (68,016_123,396) (86.57_155.6) (117,400_181,455) (110.38_166.46) (−0.24_0.69) (−0.05_0.44) (−0.27_1.3)
High income Asia Pacific 122,455 112.95 158,742 106.56 167,714 101.18 −0.06 −0.05 −0.10
(117,885_129,485) (108.81_119.08) (146,007_166,359) (99.17_110.83) (147,322_181,069) (89.47_107.95) (−0.13_−0.01) (−0.11_0) (−0.22_−0.04)
High-income North America 379,316 213.28 431,287 169.74 472,990 156.34 −0.20 −0.08 −0.27
(348,905_393,040) (197.04_220.61) (409,559_454,891) (162.06_178.54) (439,017_512,580) (145.58_170.22) (−0.24_−0.06) (−0.12_−0.03) (−0.32_−0.12)
North Africa and Middle East 73,601 73.08 164,656 89.41 243,815 98.96 0.22 0.11 0.35
(52,486_138,533) (52.72_134.44) (136,613_195,335) (75.5_104.44) (198,307_284,283) (80.8_115.45) (−0.24_0.57) (−0.06_0.25) (−0.28_0.88)
Oceania 1,072 58.03 2,600 78.61 3,792 85.48 0.35 0.09 0.47
(746_2,321) (41.17_120.04) (1,753_5,461) (54.55_160.35) (2,478_7,547) (57.56_163.77) (−0.05_0.8) (−0.1_0.3) (−0.02_1.12)
South Asia 240,840 72.96 600,648 100.73 982,473 125.29 0.38 0.24 0.72
(175,112_367,236) (54.54_107.75) (495,098_712,102) (83.96_120.24) (748,576_1,238,008) (95.91_157.33) (0.01_0.78) (−0.03_0.5) (0.05_1.4)
Southeast Asia 174,387 100,000.20 377,549 131.96 517,385 144.22 0.25 0.09 0.37
(136,906_257,864) (84.05_152.22) (308,892_529,499) (108.83_184.4) (404,021_726,116) (112.72_201.78) (−0.07_0.48) (−0.09_0.28) (−0.15_0.73)
Southern Latin America 40,143 159.59 57,760 161.45 65,518 154.93 0.01 −0.04 −0.03
(35,416_47,236) (140.67_187.64) (55,145_61,000,000) (154.4_169.9) (60,158_73,658) (142.56_173.7) (−0.14_0.17) (−0.12_0.05) (−0.21_0.18)
Southern Sub-Saharan Africa 17,900 102.03 37,842 133.60 48,660 138.52 0.31 0.04 0.36
(15,425_21,180) (86.65_122.2) (32,057_44,228) (112.58_155.5) (39,766_58,352) (113.33_166.72) (0.07_0.59) (−0.18_0.2) (0.05_0.64)
Tropical Latin America 66,749 118.23 123,293 118.66 153,726 115.92 0.00 −0.02 −0.02
(63,747_69,433) (112.6_123.15) (118,391_128,048) (113.77_123.17) (140,925_167,334) (106.16_126.13) (−0.04_0.05) (−0.1_0.06) (−0.11_0.07)
Western Europe 624,896 218.59 609,658 167.25 626,364 154.84 −0.23 −0.07 −0.29
(553,975_645,271) (192.34_225.71) (571,733_636,265) (159.46_174.52) (569,657_678,617) (142.25_167.85) (−0.27_−0.09) (−0.13_−0.02) (−0.36_−0.13)
Western Sub-Saharan Africa 26,988 53.43 65,609 73.62 111,798 89.45 0.38 0.21 0.67
(20,466_38,668) (40.56_76.88) (50,220_81,727) (56.18_91.1) (80,399_150,518) (63.79_120.33) (−0.03_0.86) (−0.08_0.59) (0_1.47)

Discussion

OC is one of the diseases that affect all parts of the world [16]. Overall ASIR of OC increased from 1990 until 2019. During this period, the rate of OC has almost doubled. It is believed that lifestyle changes and the development of the Western lifestyle in the areas of reproductive behaviors, age at marriage, and reduced desire for childbearing and breastfeeding, may be responsible for part of this upward trend [8, 16]. On the other hand, the improvement in diagnostic methods has changed the statistics of this cancer [17]. Also, improving cancer registration, especially in recent years with the correct registration of new cases, has contributed to the current changes in this trend [18]. However, with the formation of the Covid-19 crisis in recent years, the world will witness a change in cancer statistics [19].

The highest mortality rate and ASR of OC are seen in high-income areas. In terms of WHO classification, Europe is ahead of the rest of the world. Despite recent advances in the management and treatment of patients with OC in recent years, the global mortality rate of this cancer has not declined [7, 17, 20]. Due to the lack of specific symptoms, patients with OC are diagnosed with an advanced stage [21]. In addition, current treatments, such as debulking surgery and adjuvant chemotherapy, have an overall response rate of 80 %. However, significant proportions of patients experience a disease reoccurrence after the initial response to treatment and eventually die from it. In general, the OC’s prognosis is not good, and patients diagnosed in advanced stages have a 5 years survival rate of only 17 % [22]. Given that the majority of OC cases occur in women over 60 years of age and the elderly [23], old age and the resulting weakness are a factor in the increase in recurrence rate and decrease in survival in women’s cancers. Frailty has been proven to increase vulnerability, decrease health response, increase falls, require long-term care, and lead to mortality [24]. To select the best treatment method for elderly patients, it is recommended to use the Modified Frailty Index to assess their frailty before surgery [25]. Also, a meta-analysis result showed that the postoperative mortality rate for OC after primary or interval cytoreductive surgery was 1.92 %. The risk of developing postoperative complications increases with increased age, albumin level 3.5 g/dL, ascites on CT scan, stage IV disease, and extensive surgical procedures. Also, their findings revealed that patients who underwent neoadjuvant chemotherapy and interval debulking surgery had a lower chance of developing severe complications compared to individuals who had primary debulking surgery [26].

Reduced protective factors such as pregnancy and breastfeeding, have a negative effect on the incidence of the disease and lead to inequalities in the disease onset and treatment. In summary, the highest incidence and mortality of OC are seen in high SDI regions. BRCA mutation which is one of the most important risk factors for this cancer, is more common in European countries [27].

According to scientific findings, higher ovulatory cycles throughout life increases risk of OC [28, 29]. Although the definitive 10 years risk of OC is low, increasing the ovulatory cycles from 300 to 500 doubles the risk of OC. The reason for this can be related to inflammation that occurs after each ovulation period, which can lead to OC [28]. Accordingly, increased use of oral contraceptive pills by reducing the ovulatory cycles has helped to reduce OC in some countries [30].

Parity has a protective role against OC. Therefore, in areas where the number of deliveries per woman is higher, the rate of OC is lower [31, 32]. Morch believes that postmenopausal hormone therapy is associated with an increased risk of OC, regardless of the length of use, formulation, estrogen dose, type of diet, type of progesterone, and method of use [33]. Therefore, some societies have seen a change in OC incidence by limiting the use of these treatments, and this change is more pronounced in areas where hormone therapy has been more common [34].

The link between smoking and the increased risk of OC is biologically comprehensible. In addition to being a risk factor for OC, smoking can increase the risk of death by up to 25 %. The risk of some types of OC increases with increasing smoking, and 20–30 years after quitting smoking, the risk returns to baseline [35]. Therefore, the statistics of OC are likely to increase with the increasing smoking.

Obesity has also been found to increase OC through a hormonal mechanism, by which androgen conversion in peripheral tissues increases the risk of OC [36]. The risk of ovarian epithelial cancer is 30 times higher in obese women than in women with a normal BMI range [37]. In addition to increasing the incidence, obesity reduces the OC survival rate in cases of localized disease, which increases the risk of death. Over the past 50 years, obesity has become a global pandemic. The high prevalence of obesity in Western countries can change the statistics of this cancer in these countries [30]. However, in addition to obesity, the role of other factors must be considered and the relationship between the prevalence of OC and obesity in the world must be investigated future [38].

The key to reducing OC remains in primary prevention [39]. Approaches such as weight loss, a healthy lifestyle and diet, promoting childbearing and breastfeeding, and recommending the use of oral contraceptives in eligible individuals can have a protective effect against this silent killer [1]. In addition, part of the reduction in OC-related mortality can be attributed to early diagnosis. Therefore, it is possible to contribute to the early diagnosis of this disease by improving diagnostic methods, screening high-risk individuals, and raising awareness [40, 41]. On the other hand, improving diagnostic and therapeutic methods also affect the mortality rate of this cancer [42]. Finally, proper registration of affected patients to extract accurate statistics is another issue that governments should address [43].

This study has some limitations which are mentioned below; first, despite the fact that GBD has gathered data from various sources, the results can be impacted by the limitation in data availability in some regions. In addition, in some low-income countries, the absence of sources such as cancer registry data and cytological results could result in inaccurate estimations.

Conclusion

The major finding of the present study is the increasing trend of OC incidence and burden and approximately stable mortality trend from 1990 to 2019; especially in lower socioeconomic areas and low-income countries; while the incidence ASR of this cancer in the high SDI regions decreased in 1990–2019. It seems that primary prevention is the main key to reducing OC. Therefore, Approaches such as identifying at-risk groups using history and BRCA-testing, weight loss, a healthy lifestyle and diet, promoting childbearing and breastfeeding, and recommending the use of oral contraceptives in eligible individuals can have a protective effect against this silent killer. In addition to improving diagnostic and therapeutic methods, it is possible to contribute to the early diagnosis of this disease by screening high-risk individuals and raising awareness.

Corresponding author: Hamid Salehiniya, Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran, E-mail:

Acknowledgments

NA.

  1. Research ethics: The study was approved by the ethics committee of the Birjand University of Medical Sciences (ethics committee approval code IR.BUMS.REC.1400.316).

  2. Informed consent: Consent was not necessary for this study because it utilized online data. All procedures were performed under the relevant guidelines and regulations.

  3. Author contributions: The authors confirm their contribution to the paper as follows: study conception and design: HS, AM, LA; data collection: MA; analysis and interpretation of results: MA, HS, YK, ARS; draft manuscript preparation: MA, ZM, HS, LA. All authors reviewed the results and approved the final version of the manuscript.

  4. Competing interests: All authors declare that they have no conflicts of interest.

  5. Research funding: NA.

  6. Data availability: The data presented in this study are available on request from the corresponding author.

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Received: 2023-05-05
Accepted: 2023-10-25
Published Online: 2023-11-13

© 2023 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/oncologie-2023-0172
Keywords for this article
burden; incidence; mortality; trend; ovarian cancer
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Review Articles
  3. Mitochondrial thermogenesis in cancer cells
  4. Application of indocyanine green in the management of oral cancer: a literature review
  5. Long non-coding RNA, FOXP4-AS1, acts as a novel biomarker of cancers
  6. The role of synthetic peptides derived from bovine lactoferricin against breast cancer cell lines: a mini-review
  7. Single cell RNA sequencing – a valuable tool for cancer immunotherapy: a mini review
  8. Research Articles
  9. Global patterns and temporal trends in ovarian cancer morbidity, mortality, and burden from 1990 to 2019
  10. The association between NRF2 transcriptional gene dysregulation and IDH mutation in Grade 4 astrocytoma
  11. More than just a KRAS inhibitor: DCAI abrogates the self-renewal of pancreatic cancer stem cells in vitro
  12. DUSP1 promotes pancreatic cancer cell proliferation and invasion by upregulating nephronectin expression
  13. IMMT promotes hepatocellular carcinoma formation via PI3K/AKT/mTOR pathway
  14. MiR-100-5p transfected MSCs-derived exosomes can suppress NSCLC progression via PI3K-AKT-mTOR
  15. Inhibitory function of CDK12i combined with WEE1i on castration-resistant prostate cancer cells in vitro and in vivo
  16. Prognostic potential of m7G-associated lncRNA signature in predicting bladder cancer response to immunotherapy and chemotherapy
  17. Case Reports
  18. A rare FBXO25–SEPT14 fusion in a patient with chronic myeloid leukemia treatment to tyrosine kinase inhibitors: a case report
  19. Stage I duodenal adenocarcinoma cured by a short treatment cycle of pembrolizumab: a case report
  20. Rapid Communication
  21. ROMO1 – a potential immunohistochemical prognostic marker for cancer development
  22. Article Commentary
  23. A commentary: Role of MTA1: a novel modulator reprogramming mitochondrial glucose metabolism
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