Ovarian Cancer Facts and Figures GEMSTONE Educational Module Last Update: April 2, 2018 GEMSTONE, a committee of ovarian cancer experts, provided direction and approval of the material in this educational resource. TESARO, Inc. provided writing and organizational support to GEMSTONE in the generation of this material.

Module Objectives Describe public health burden of ovarian cancer in United States Review shifting trends in ovarian cancer incidence and mortality Identify how incidence and mortality differ across patient demographics Compare NIH funding levels for ovarian and breast cancers NIH, National Institutes of Health.

Module Outline Ovarian Cancer Statistics Risk Factors and Epidemiology by Ethnicity Current Needs Summary and Unresolved Questions

Ovarian Cancer Statistics

Ovarian Cancer Is Relatively Rare Compared With Other Cancers Incidence in United States 222,060 Prevalence in United States 11.7 22,240 new cases per 100,000 women per yeara 2018 total new diagnoses2 based on diagnoses between 1975 and 2014b 1.3% 2.8% Proportion of all new cancer diagnoses in United States Proportion of all US cancer diagnoses in women up to 2014c A woman’s lifetime risk of getting ovarian cancer is about 1 in 782 a Age-adjusted data from 2010-2014. b Derived from maximum limited-duration prevalence between 1975 and 2014 for all years since diagnosis and US Census Bureau data. c Complete prevalence of ovarian cancer (222,060 in the United States between 1975 and 2014) divided by the complete prevalence of all cancers in women (7,866,096 in the United States between 1975 and 2014). 1. National Cancer Institute. SEER Cancer Stat Facts: Ovarian Cancer. http://seer.cancer.gov/statfacts/html/ovary.html. Published April 2017. Accessed April 2, 2018. 2. American Cancer Society. What Are the Key Statistics About Ovarian Cancer?. https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html. Last revised January 5, 2018. Accessed April 2, 2018.

Ovarian Cancer Is the Most Lethal Gynecologic Cancer Mortality in United States Overall estimated 5-year survival in United States 46.5% 7.4 14,070 deaths per 100,000 women per yeara 2018 estimated total deaths2 92.5 73.0 28.9 15.0 20.0 60.0 Most ovarian cancer diagnoses occur after metastasis, when survival rates decline Estimated 5-year survival Percentage of diagnosed cases by stage a Age-adjusted data from 2010-2014. 1. National Cancer Institute. SEER Cancer Stat Facts: Ovarian Cancer. http://seer.cancer.gov/statfacts/html/ovary.html. Published April 2017. Accessed April 2, 2018. 2. American Cancer Society. What Are the Key Statistics About Ovarian Cancer?. https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html. Last revised January 5, 2018. Accessed April 2, 2018.

Epidemiological Trends Show a Decline in Ovarian Cancer Incidence and Mortality Over the last decade, ovarian cancer incidence has declined by 1.9% on average each year, while mortality has declined by 2.2% on average each year New Cases 2014 Number per 100,000 Women Deaths 2014 Year National Cancer Institute. SEER Cancer Stat Facts: Ovarian Cancer. http://seer.cancer.gov/statfacts/html/ovary.html. Published April 2017. Accessed April 2, 2018.

Mortality of ovarian cancer1 vs breast cancer2 Ovarian Cancer Mortality Has Remained Relatively Stable Compared With Breast Cancer Mortality of ovarian cancer1 vs breast cancer2 Breast cancer Deaths per 100,000 Women Ovarian cancer Year 1. National Cancer Institute. SEER Cancer Stat Facts: Ovarian Cancer. http://seer.cancer.gov/statfacts/html/ovary.html. Published April 2017. Accessed April 2, 2018. 2. National Cancer Institute. SEER Cancer Stat Facts: Female Breast Cancer. https://seer.cancer.gov/statfacts/html/breast.html. Published April 2017. Accessed April 2, 2018.

Median Age of Ovarian Cancer Diagnosis Is 63 Years Age distribution Median age at ovarian cancer diagnosis1 63 years Median age at ovarian cancer diagnosis in women with a BRCA1/2 mutation2 BRCA1 52 years BRCA2 59 years 1. National Cancer Institute. SEER Cancer Stat Facts: Ovarian Cancer. http://seer.cancer.gov/statfacts/html/ovary.html. Published April 2017. Accessed April 2, 2018. 2. Norquist BM, et al. JAMA Oncol. 2016;2(4):482-90.

Median Age of Ovarian Cancer Death Is 70 Years Age distribution Median age at death due to ovarian cancer 70 years National Cancer Institute. SEER Cancer Stat Facts: Ovarian Cancer. http://seer.cancer.gov/statfacts/html/ovary.html. Published April 2017. Accessed April 2, 2018.

Risk Factors and Epidemiology by Ethnicity

Hereditary Cancer Syndromes Risk and Protective Factors Associated With Likelihood of Developing Epithelial Ovarian Cancer Risk Factors Protective Factors Age Obesity Full-Term Pregnancy OCP Use Breast- feeding Fertility Drugs Hereditary Cancer Syndromes Tubal Ligation Hysterectomy OCP, oral contraceptive pills. American Cancer Society. What Are the Risk Factors for Ovarian Cancer?. https://www.cancer.org/cancer/ovarian- cancer/causes-risks-prevention/risk-factors.html. Last revised February 4, 2016. Accessed April 2, 2018.

Incidencea by Ethnicity Mortalityb by Ethnicity Ovarian Cancer Incidence and Mortality Rates Are Highest in White Women But Affect All Ethnicities Incidencea by Ethnicity Mortalityb by Ethnicity All Races White Black Asian/ Pacific Islander American Indian/ Alaska Native Hispanic Non-Hispanic 11.7 12.2 9.4 9.5 10.6 11.8 7.4 7.7 6.4 4.4 6.2 5.4 7.6 Age-adjusted data from 2010-2014. a Number of new cases per 100,000 persons. b Number of deaths per 100,000 persons. National Cancer Institute. SEER Cancer Stat Facts: Ovarian Cancer. http://seer.cancer.gov/statfacts/html/ovary.html. Published April 2017. Accessed April 2, 2018.

Black Women With Ovarian Cancer Have a Lower 5-Year Survival Rate Than White Women 5-year survival in gynecologic cancers by race (2006-2012, all stages): 69 84 68 82 46 46 5-Year Survival (%) 57 62 36 Siegel RL, et al. CA Cancer J Clin. 2017;67(1):7-30.

Current Needs

NIH Funding: Ovarian & Breast Cancer Additional Research Funding Is Necessary to Improve Outcomes for Women With Ovarian Cancer NIH Funding: Ovarian & Breast Cancer Ovarian Cancer $144 million Breast Cancer $656 million Total NIH Spending, 2016 (in millions) Ovarian Cancer Breast Cancer Annual mortalitya 51,103 US prevalence ratea 0.4% US prevalence ratea 1.6% Annual mortalitya 14,972 total funded projects 319 total funded projects 1693 a Derived from consistent and nationally representative 2015 disease statistics provided by National Center for Heath Statistics at the Center for Disease Control and Prevention. NIH, National Institutes of Health. National Institutes of Health. Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC). Research Portfolio Online Reporting Tools (RePORT). https://report.nih.gov/categorical_spending.aspx. Published July 3, 2017. Accessed April 2, 2018.

Summary and Unresolved Questions

Module Summary Ovarian cancer is relatively rare but relatively lethal1 Survival is correlated with extent of disease spread at diagnosis1 Estimated 5-year survival in United States: Localized disease: 92.5% Distant disease: 28.9% Ovarian cancer mortality and incidence are declining slightly1 Certain factors may affect risk for ovarian cancer and potential prognosis1,2 1. National Cancer Institute. SEER Cancer Stat Facts: Ovarian Cancer. http://seer.cancer.gov/statfacts/html/ovary.html. Published April 2017. Accessed April 2, 2018. 2. American Cancer Society. What Are the Risk Factors for Ovarian Cancer?. https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/risk-factors.html. Last revised February 4, 2016. Accessed April 2, 2018.

Unresolved Questions How can women modify their diet and lifestyle choices to decrease risk of ovarian cancer? How does obesity affect risk of ovarian cancer? How can we improve screening and earlier detection?

GEMSTONE GEMSTONE, a committee of ovarian cancer experts, provided direction and approval of the material in this educational resource. TESARO, Inc. provided writing and organizational support to GEMSTONE in the generation of this material. TESARO, Inc. | 1000 Winter Street, Suite 3300 | Waltham, MA 02451 ©2018 TESARO, Inc. All rights reserved. PP-DS-US-0067 05/18