Globally, ovarian cancer is the eighth most common cancer in women, accounting for an estimated 3.7% of cases and 4.7% of cancer deaths in 2020. Until the early 2000s, age-standardized incidence was highest in northern Europe and North America, but this trend has changed; incidence is now declining in these regions and increasing in parts of eastern Europe and Asia. Ovarian cancer is a very heterogeneous disease and, even among the most common type, namely epithelial ovarian cancer, five major clinically and genetically distinct histotypes exist. Most high-grade serous ovarian carcinomas are now recognized to originate in the fimbrial ends of the fallopian tube. This knowledge has led to more cancers being coded as fallopian tube in origin, which probably explains some of the apparent declines in ovarian cancer incidence, particularly in high-income countries; however, it also suggests that opportunistic salpingectomy offers an important opportunity for prevention. The five histotypes share several reproductive and hormonal risk factors, although differences also exist. In this Review, we summarize the epidemiology of this complex disease, comparing the different histotypes, and consider the potential for prevention. We also discuss how changes in the prevalence of risk and protective factors might have contributed to the observed changes in incidence and what this might mean for incidence in the future.

在全球范围内，卵巢癌是女性第八大常见癌症，预计 2020 年占病例数的 3.7%，占癌症死亡人数的 4.7%。直到 2000 年代初，北欧和北美的年龄标准化发病率最高，但这趋势已经改变；目前这些地区的发病率正在下降，而东欧和亚洲部分地区的发病率正在上升。卵巢癌是一种异质性非常强的疾病，即使在最常见的类型（即上皮性卵巢癌）中，也存在五种主要的临床和遗传不同的组织型。现在大多数高级别浆液性卵巢癌被认为起源于输卵管伞端。这一知识导致更多的癌症被编码为起源于输卵管，这可能解释了卵巢癌发病率明显下降的一些原因，特别是在高收入国家；然而，它也表明机会性输卵管切除术提供了重要的预防机会。尽管也存在差异，但这五种组织型共有一些生殖和激素危险因素。在这篇综述中，我们总结了这种复杂疾病的流行病学，比较了不同的组织型，并考虑了预防的潜力。我们还讨论了风险和保护因素发生率的变化如何导致观察到的发病率变化，以及这对未来的发病率可能意味着什么。