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Obesity is not just a cosmetic issue—it is a clinical and biological risk factor and progression driver for ovarian cancer
Ovarian cancer is the fifth most common reason for female cancer-related deaths in the United States and is responsible for more female reproductive cancer deaths than any other type
Ovarian cancer is among the deadliest gynaecologic cancers, usually diagnosed late because of its nonspecific presentation. Although genetic predisposition and reproductive factors are established risk factors, increasing evidence points towards obesity as an important, modifiable risk factor. As obesity is increasing worldwide, its association with ovarian cancer has become increasingly prominent for prevention, early detection, and better therapeutic results. Dr Vishnu Agarwal, Surgical Oncologist, Saifee Hospital, Mumbai shares all you need to know about the hidden link
The Growing Obesity Burden
Obesity, which is a body mass index (BMI) of ≥30 kg/m², has become an epidemic in all parts of the globe. The World Health Organization (WHO) states:
Over 1 billion people in the world were obese in 2022.
Adult obesity in the US was 42.4% as of 2020, which is a steep rise from 30.5% in 2000 (CDC).
The trend is strongly relevant to cancer incidence, including ovarian cancer.
Ovarian Cancer: The Silent Killer
Ovarian cancer is the fifth most common reason for female cancer-related deaths in the United States and is responsible for more female reproductive cancer deaths than any other type. The American Cancer Society estimates:
In 2024, an estimated 19,680 women in the United States will develop ovarian cancer.
About 12,740 deaths will occur due to the disease.
The five-year survival rate for ovarian cancer is typically low, just 49%, largely because it is typically diagnosed late.
Biological Mechanisms that Connect Obesity and Ovarian Cancer
1. Overproduction of Estrogen
Excess fat tissue results in peripheral conversion of androgens to estrogens, particularly after menopause. Estrogen stimulates growth in cells of the ovary, potentially increasing the chance of mutation and tumor formation.
2. Inflammation
Obesity causes chronic inflammation with elevated cytokine levels, including TNF-α, IL-6, and CRP. Chronic inflammation results in DNA damage and may cause tumor development.
3. Insulin Resistance and IGF-1
Obesity is associated with insulin resistance, leading to raised levels of insulin and insulin-like growth factor-1 (IGF-1). Both exhibit mitogenic and anti-apoptotic properties, which may promote the survival and growth of ovarian tumor cells.
4. Adipokines and Leptin
Adipokines are hormones secreted by fat tissue. Among them, leptin is increased in obesity and has been reported to promote proliferation of cancer cells and ovarian tumor angiogenesis.
Epidemiological Evidence
Multiple large-scale studies have measured the association of BMI and risk of ovarian cancer:
A meta-analysis in Cancer (2013) of more than 20 cohort studies concluded that an increase of 5 units in BMI was linked to a 10% higher risk of ovarian cancer.
A WCRF study found that increased body fatness is “likely” to be a cause of ovarian cancer, particularly for non-serous subtypes.
Obese ovarian cancer patients also experience worse prognosis, including:
• Increased disease recurrence following treatment.
• Decreased overall survival, with stage and treatment type controlled for.
• Increased rates of surgery and chemotherapy complications.
• Implications for Prevention and Management
From evidence, obesity is a modifiable risk factor for ovarian cancer. Prevention measures are:
• Diet and exercise weight control.
• Public health prevention policies against obesity from a young age.
• Risk stratification and screening of high-BMI groups.
• In practice, oncologists will have to modify the treatment of obese patients, including individualized chemotherapy dosing and more aggressive surgery to improve outcomes.
Obesity is not just a cosmetic issue—it is a clinical and biological risk factor and progression driver for ovarian cancer. As the epidemic of obesity marches forward, so must the need to incorporate prevention, awareness, and targeted treatment strategies into women’s health policy. Prevention of obesity has the potential to dramatically decrease the burden of ovarian cancer and enhance survival in thousands of women worldwide.60
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