Introduction Despite the publication of numerous well-designed studies on the association between asbestos exposure and ovarian cancer since the 2012 IARC Monograph on asbestos, no comprehensive meta-analysis has been conducted to date. In the present study, a meta-analysis was performed by integrating studies published both before and after the 2014 Helsinki update on Asbestos.

Methods A systematic review of the literature available on PubMed, EMBASE, and the Cochrane Library in July 2022 was conducted to identify relevant studies. Mesh terms and queries were selected based on the advice of a librarian, and included key concepts such as ‘asbestos,’ ‘crocidolite,’ ‘serpentine,’ ‘ovarian cancer,’ ‘ovarian neoplasms,’ and ‘ovary tumor.’

Results The present analysis includes 18 studies published between 1982 and 2022, reporting data from 1941 to 2015 and involving more than 74,574 participants from 9 countries. An analysis of 16 studies before and after the 2014 Helsinki update found that the overall summary Standardized Mortality Ratio (SMR) was 1.74 (95% CI, 1.46–2.08; P = 0.0440; 17 records). Among the integrated studies, five cohort studies reported a strong correlation between mortality from ovarian cancer and occupational high-intensity asbestos exposure.

Conclusion/Implications The significance of the current study is that it is the first meta-analysis to incorporate both the Helsinki-included studies and subsequent publications. It revealed a significant increase in SMR for ovarian cancer, even in the studies published after the 2012 IARC Monograph. To enhance future research, it is recommended to investigate women diagnosed with ovarian cancer after 1999 using the SIR method, particularly regarding environmental exposure.