Do women with polycystic ovary syndrome (PCOS) have an increased risk of ovarian cancer?

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Last updated: October 5, 2026 • View editorial policy

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PCOS and Ovarian Cancer Risk

Women with PCOS have a modestly increased risk of certain ovarian tumors—specifically borderline ovarian tumors and non-epithelial ovarian cancers (particularly stromal tumors)—but do NOT have an increased risk of the most common epithelial ovarian cancers.

The Evidence on Ovarian Cancer Risk

The relationship between PCOS and ovarian cancer is nuanced and depends critically on tumor subtype:

Epithelial Ovarian Cancer (Most Common Type)

  • No increased risk for standard epithelial ovarian cancer 1, 2
  • The most recent and highest-quality Swedish cohort study (2025) with 25-year follow-up of nearly 480,000 women found adjusted HR: 1.00 (95% CI 0.64-1.55) for epithelial ovarian cancer 1
  • A Danish nationwide study similarly found no marked association with overall epithelial ovarian cancer 2

Borderline Ovarian Tumors

  • Significantly increased risk: HR 1.61 (95% CI 1.16-2.23) 1
  • Serous borderline tumors specifically show elevated risk: HR 2.34 (95% CI 1.21-4.53) 2

Non-Epithelial Ovarian Cancers

  • Substantially increased risk: HR 4.26 (95% CI 2.50-7.03) 1
  • Stromal tumors show the highest risk—approximately 7-fold increased 1
  • This makes biological sense given PCOS involves hormonal dysregulation affecting ovarian stroma

Meta-Analysis Findings

Recent meta-analyses show pooled estimates:

  • Overall ovarian cancer risk: RR 1.52 (95% CI 1.17-1.97) 3
  • Pooled OR 1.3 (95% CI 1.0-1.8) 4

Clinical Context: What This Means

Important Caveats

  1. Non-epithelial ovarian cancers are rare - despite the high relative risk, absolute risk remains low 1
  2. No screening is recommended - even the highest-quality studies conclude screening or altered follow-up is not indicated 1
  3. Confounding factors matter - obesity is a major confounder that partially explains associations 5

Guideline Recommendations

The Royal College of Obstetricians and Gynaecologists explicitly states: no additional surveillance for ovarian cancer is recommended in women with PCOS 6.

The 2013 Endocrine Society PCOS guidelines do not recommend routine ovarian cancer screening 7.

What You Should Actually Do

Focus on endometrial cancer risk instead - this is where PCOS creates clinically significant cancer risk:

  • 3-fold increased risk of endometrial cancer (RR 2.7-3.5) 7
  • Shared risk factors: obesity, hyperinsulinism, diabetes, abnormal uterine bleeding 7

For endometrial protection:

  • Induce withdrawal bleeding with progesterone every 3-4 months in women with prolonged amenorrhea (>90 days) 6
  • Evaluate endometrium with transvaginal ultrasound if abnormal bleeding, spotting, or prolonged amenorrhea occurs 6
  • Consider endometrial biopsy/hysteroscopy for thickened endometrium or polyps 6

For ovarian considerations:

  • Maintain routine gynecologic care
  • No special ovarian cancer screening protocols needed
  • Address modifiable risk factors (obesity, metabolic syndrome)

The Bottom Line

While PCOS increases risk for borderline and stromal ovarian tumors, these are uncommon. The lack of increased epithelial ovarian cancer risk (the predominant type) means standard gynecologic surveillance is appropriate—no enhanced ovarian cancer screening is warranted. Direct your clinical attention instead to the well-established endometrial cancer risk and metabolic complications of PCOS.

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.