Disparities Persist Despite Declining US Ovarian Cancer Death Rates

Ovarian cancer mortality rates in the US declined from 1999 to 2020, but disparities remain across age, race, and geographic regions, according to a study published in the World Journal of Clinical Oncology.¹

Despite advances in cancer treatment, such as precision medicine, immunotherapy, and antibody-drug conjugates, late-stage diagnosis remains a major barrier to ovarian cancer survival due to the lack of a routine screening program. As a result, survival rates for stage III and IV ovarian cancer remain low, at about 40% and 20%, respectively.²

Ovarian cancer mortality rates in the US declined from 1999 to 2020, but significant disparities remain, highlighting the need for targeted public health efforts. | Image Credit: iiierlok_xolms - stock.adobe.com

To better understand mortality trends, the researchers conducted a retrospective analysis of US women aged 25 and older using de-identified death certificate data from the CDC Wide-Ranging Online Data for Epidemiologic Research database.¹ The study analyzed demographic and regional differences in ovarian cancer-related deaths from 1999 to 2020, aiming to identify high-risk populations and shifts in epidemiology throughout the study period.

The researchers calculated both crude and age-adjusted mortality rates (AAMRs) per 100,000 people and used the Joinpoint Regression Program to assess annual percent changes (APCs), with statistical significance set at P < .05.

Between 1999 and 2020, 337,619 females aged 25 years and older died from ovarian cancer in the US. In terms of location, 41% of these deaths occurred at home, 29% in medical facilities, 13% in long-term care or nursing home facilities, and 8% in hospice settings.

At the beginning of the study period, the overall AAMR was 14.62 per 100,000. This rate remained relatively stable until 2003, when it reached 14.7 per 100,000 (APC, 0.41; 95% CI, –0.48 to 1.79). After 2003, the AAMR significantly declined, falling to 10.15 per 100,000 by 2020 (APC, –2.28; 95% CI, –2.39 to –2.16).

When examining age-specific trends, women aged 65 and older consistently had the highest AAMRs, with a total rate of 42.41 per 100,000 (95% CI, 42.23-42.59). This group experienced a brief increase in AAMR from 1999 to 2001, followed by a steady decline until 2007. From 2007 through 2020, a significant decrease occurred, reaching 33.01 per 100,000 by 2020 (APC, –2.88; 95% CI, –3.12 to –2.67).

In comparison, women aged 45 to 64 years had a total AAMR of 11.09 per 100,000 (95% CI, 11.02-11.16), while those aged 25 to 44 had the lowest rate at 1.16 per 100,000 (95% CI, 1.14-1.19). Both younger and middle-aged groups showed continuous, significant decreases in AAMR trends throughout the study period.

Racial and ethnic disparities were also evident. Non-Hispanic White women had the highest total AAMR at 13.53 per 100,000 (95% CI, 13.48-13.58), followed by non-Hispanic Black women (11.02; 95% CI, 10.89-11.15), non-Hispanic American Indian or Alaska Native women (9.85; 95% CI, 9.34-10.36), Hispanic or Latina women (8.94; 95% CI, 8.81-9.07), and non-Hispanic Asian or Pacific Islander women (7.56; 95% CI, 7.4-7.73).

All groups showed declines in AAMR by 2020, though trends varied. Non-Hispanic American Indian or Alaska Native and non-Hispanic Asian or Pacific Islander women experienced steady declines from 1999 to 2020. Non-Hispanic Black women saw an initial increase, followed by a continuous significant decline after 2002 (APC, –1.71; 95% CI, –3.26 to –1.46). Meanwhile, non-Hispanic White women had 2 significant periods of decline beginning in 2002 (2002-2006; 2006-2020). Hispanic or Latina women had stable AAMR rates until 2005, followed by a sharp decline through 2020 (APC, –1.72; 95% CI, -2.77 to –1.41).

Although overall AAMRs were similar between metropolitan and non-metropolitan areas, non-metropolitan regions had a slightly higher rate (AAMR, 12.84; 95% CI, 12.74-12.95) than metropolitan areas (AAMR, 12.61; 95% CI, 12.58-12.66). Both groups had stable AAMRs in the early 2000s, followed by significant declines through 2020. Metropolitan areas showed a slightly steeper decline from 2003 to 2020 (APC, –2.31; 95% CI, –2.45 to –2.19), while non-metropolitan areas declined at a slower rate from 2004 to 2020 (APC, –2.20; 95% CI, –2.47 to –1.98).

By geographic region, the Northeast had the highest total AAMR at 13.06 per 100,000 (95% CI, 12.96-13.16), followed by the Midwest (12.94; 95% CI, 12.85-13.03), the West (12.86; 95% CI, 12.76-12.95), and the South (12.16; 95% CI, 12.09-12.23).

Both the Northeast and Midwest showed initial AAMR increases through 2002 and 2003, respectively, followed by significant declines through 2020. The South experienced 2 periods of decline, from 1999 to 2005 and 2005 to 2020, with the second being statistically significant. In contrast, the West’s AAMRs remained stable from 1999 to 2004, followed by 3 distinct periods of decline between 2004 and 2020.

Lastly, the researchers acknowledged their study’s limitations, including the lack of individual-level data on lifestyle factors, tumor histology, and treatment protocols, which limited their ability to draw causal conclusions. Still, they called for public health efforts to address the disparities identified in their analysis.

“Despite overall progress, geographic and demographic disparities persist, underscoring the need for targeted preventive strategies and equitable health care interventions to further decrease ovarian cancer mortality,” the authors wrote.

References

1. Razaq L, Dhali A, Maity R, et al. Demographic trends in mortality due to ovarian cancer in the United States, 1999-2020. World J Clin Oncol. 2025;16(6):108393. doi:10.5306/wjco.v16.i6.108393
2. Arnaoutoglou C, Dampala K, Anthoulakis C, et al. Epithelial ovarian cancer: a five year review. Medicina (Kaunas). 2023;59(7):1183. doi:10.3390/medicina59071183