Ovarian Cancer Is Still Killing Too Many Women

What a 2025 JAMA review reveals about why early detection remains elusive

The Issue, Defined Clearly

Ovarian cancer is a malignant disease of the ovaries that is usually diagnosed late, often after it has already spread beyond the pelvis. Because early symptoms are vague and there is no effective screening test, most women present with advanced-stage disease. This late diagnosis is the main reason ovarian cancer remains one of the deadliest gynecologic cancers.

That reality has not changed much, despite decades of research.

A 2025 narrative review by Caruso et al., published in JAMA, takes a hard look at where we stand today. The paper is sober, data-driven, and quietly unsettling. It confirms progress in treatment but underscores a stubborn truth: we still fail at early detection, and that failure costs lives.

What the Evidence Shows

The review makes several points that are uncomfortable but important.

First, most ovarian cancers are diagnosed at stage III or IV, when cure rates are low. Five-year survival exceeds 90 percent for stage I disease but drops to roughly 30 percent once disease is advanced. That gap is not narrowing.

Second, screening does not work. Large randomized trials evaluating CA-125 testing, transvaginal ultrasound, or combinations of the two have not reduced ovarian cancer mortality. Some increased false positives and unnecessary surgeries without improving outcomes. The review is explicit: routine screening of average-risk women causes harm without benefit.

Third, ovarian cancer is not one disease. High-grade serous carcinoma accounts for the majority of deaths and likely originates in the distal fallopian tube, not the ovary itself. Other subtypes behave differently, respond differently to therapy, and have different risk profiles. Lumping them together has slowed progress.

These points are well known individually. What the review does effectively is place them together and show how little they have changed clinical reality.

Treatment Has Improved, But Only After Diagnosis

There has been real progress in therapy. The review outlines advances in cytoreductive surgery, platinum-based chemotherapy, and targeted agents such as PARP inhibitors for women with BRCA mutations or homologous recombination deficiency.

These therapies extend progression-free survival, and in selected populations, overall survival. That matters. But it does not solve the central problem.

Treatment advances help women who already have advanced disease. They do not prevent that disease from becoming advanced in the first place. The mortality curve remains stubborn because the diagnostic curve has not moved.

This is the uncomfortable asymmetry in ovarian cancer care: we have become better oncologists but not better sentinels.

Why Symptoms and Awareness Are Not Enough

Public messaging often emphasizes “listening to your body” or recognizing symptoms such as bloating, early satiety, or pelvic discomfort. The review is careful here. These symptoms are real, but they are nonspecific and common, especially in midlife.

Relying on symptom awareness alone shifts responsibility onto women without giving them a reliable tool. It risks false reassurance when symptoms are absent and delayed evaluation when they are subtle. The evidence does not support symptom-based early detection as a population strategy.

This matters ethically. Awareness campaigns can feel empowering, but empowerment without effective action can become illusion.

Prevention Works Better Than Screening

One of the most important, and often underappreciated, points in the review is prevention.

Opportunistic salpingectomy, removal of the fallopian tubes at the time of hysterectomy or sterilization, is associated with a reduced risk of high-grade serous ovarian cancer. The biologic rationale is strong. The epidemiologic data are encouraging. Randomized trial evidence is still limited, but the signal is consistent.

This is not screening. It is risk reduction.

For women with hereditary risk, especially BRCA mutations, risk-reducing salpingo-oophorectomy remains the most effective intervention. The review is clear that timing, counseling, and long-term consequences require careful discussion, but the mortality benefit is real.

In ovarian cancer, prevention has moved further than early detection. That is unusual in oncology, and it should shape our priorities.

The Ethical Tension

There is an ethical discomfort running beneath this literature.

We are asked repeatedly why medicine cannot “just find it earlier.” The answer, supported by decades of high-quality trials, is that we have tried, and it does not work. Continuing to promise early detection without evidence risks eroding trust.

At the same time, failing to invest aggressively in prevention strategies, surgical risk reduction, and subtype-specific research reflects a different ethical failure: knowing where benefit likely lies but moving too slowly.

The review does not moralize. It does something better. It states plainly what works, what does not, and where uncertainty remains.

What Should Change

Three lessons emerge.

First, screening should not be offered outside research settings. This is not nihilism. It is honesty.

Second, prevention deserves center stage. Opportunistic salpingectomy should be discussed more routinely. Genetic risk assessment should be normalized, not treated as niche care.

Third, we must stop talking about ovarian cancer as a single entity. Research, counseling, and public communication should reflect biologic diversity, not convenience.

Closing Reflection

The tragedy of ovarian cancer is not lack of effort. It is misdirected hope.

The 2025 JAMA review by Caruso and colleagues reminds us that progress in medicine is uneven. Sometimes the ethical act is not to promise more, but to say clearly what does and does not help. Until early detection truly works, our responsibility is to prevent what we can, treat what we must, and speak honestly about both.