Global, Regional, and National Burden of Ovarian Cancer Among Women of Reproductive Age, 1990-2021, with Projections to 2040: A Global Burden of Disease Study 2021 Analysis.
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BACKGROUND: Ovarian cancer threatens survival and fertility among women of childbearing age. Global evidence on temporal trends, regional disparities, and future burden in this population remains limited. PURPOSE: This study aimed to assess the global, regional, and national burden of ovarian cancer among women of reproductive age from 1990 to 2021 and to project trends through 2040. METHODS: Data on ovarian cancer incidence, deaths, and disability-adjusted life years among women aged 15-49 years were obtained from the Global Burden of Disease Study 2021 for 204 countries and territories. Temporal patterns, geographic variation, health inequalities, and drivers of burden changes were evaluated using age-standardized rates, Joinpoint regression, inequality analysis, decomposition analysis, and Bayesian age-period-cohort modeling. RESULTS: In 2021, ovarian cancer imposed a substantial burden on women of reproductive age worldwide. From 1990 to 2021, incident cases, deaths, and disability-adjusted life years increased markedly, whereas age-standardized rates changed more modestly and rose again after 2013. The burden was unevenly distributed, with lower-sociodemographic index regions and Central Sub-Saharan Africa bearing particularly high mortality and disability-adjusted life year burdens. At the national level, high age-standardized burdens were concentrated in countries including Pakistan and Uganda. The burden increased with age and peaked among women aged 45-49 years. Population growth was the main driver of the rising absolute burden, while epidemiological change contributed substantially in middle- and low-middle-sociodemographic index regions. Projections indicated continued increases through 2040. CONCLUSION: Ovarian cancer burden increased globally among women of childbearing age. Improved case ascertainment may partly explain the post-2013 rise. Further increases are projected if current age-period-cohort patterns persist, with substantial uncertainty. These findings may inform ovarian cancer control and equitable resource allocation for women of reproductive age.