Objective: To evaluate the risk of second primary ovarian cancer following radiation therapy for cervical cancer and to explore implications for risk-reducing bilateral salpingo-oophorectomy (BSO) in this population. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database (SEER 9 registries). Patients diagnosed with cervical cancer between 1973 and 2010 who received radiation therapy and did not undergo BSO were identified. Second primary ovarian cancers were defined using SEER multiple primary rules with a minimum latency of 12 months. Standardized incidence ratios (SIRs) were calculated to compare observed versus expected ovarian cancer incidence. Histological distributions and latency intervals were analyzed. Results: Among 9,291 patients treated with radiation for cervical cancer, 42 (0.45%) developed a second primary ovarian cancer. The mean age at cervical cancer diagnosis was 56.1 years, compared to 66.4 years at ovarian cancer diagnosis. The overall SIR was 1.83 (95% confidence interval 1.32–2.47), indicating a significantly increased risk compared to the general population. Risk increased over time, with the highest SIR observed beyond 20 years. Histological distribution was similar to that of primary ovarian cancers. Conclusions: Radiation therapy for cervical cancer is associated with a sustained increase in ovarian cancer risk despite radiation-induced ovarian failure. Prior pelvic radiation should be incorporated into ovarian cancer risk assessment. In patients with additional risk factors, including family history or moderate-risk genetic variants, this increased risk may influence counseling regarding risk-reducing BSO. Individualized risk stratification should be considered in treatment planning and survivorship care.
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Conger et al. (2026) studied this question.
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