Modifiable Lifestyle and Environmental Determinants of Ovarian Cancer Risk: Implications for Primary Prevention

Ovarian cancer (OC) remains the most lethal gynecologic malignancy worldwide, largely due to late-stage diagnosis and the absence of effective screening strategies. As a result, primary prevention is a critical approach to reducing disease burden. This narrative review summarizes current evidence on modifiable lifestyle, reproductive, and environmental factors associated with OC risk, based on a comprehensive PubMed, MEDLINE, Scopus, and Web of Science search conducted through April 2026. Consistent protective associations have been reported for reproductive factors, including parity, breastfeeding, oral contraceptive use, salpingectomy, and tubal ligation. Among lifestyle factors, excess body weight is modestly associated with increased OC risk, while evidence regarding physical activity remains inconclusive. Diets rich in fiber and aligned with a Mediterranean pattern appear protective, potentially through hormonal modulation and anti-inflammatory effects. In contrast, pro-inflammatory diets high in trans fats and refined carbohydrates may increase risk, whereas omega-3 fatty acids show potential protective benefits. Chronic pelvic inflammation, particularly related to Chlamydia trachomatis infection, has been linked to elevated epithelial OC risk. Smoking demonstrates a dose-response association with mucinous tumors. Environmental exposures, including genital talc use and endocrine-disrupting chemicals such as phthalates and bisphenols, have linked to a possible, albeit modest, increase in risk, although the causal mechanisms remain uncertain. Although individual associations are generally modest, their cumulative population impact may be substantial. Integrating lifestyle-based prevention strategies into gynecologic practice and public health initiatives could represent a cost-effective approach to reducing OC incidence and improving women's health outcomes.