Abstract: Objective To analyze the incidence and mortality of ovarian cancer in cancer registration areas of Heilongjiang Province in 2022, as well as the changing trends from 2018 to 2022, and to provide evidence for the prevention and control of ovarian cancer in Heilongjiang Province.Methods Data on the incidence, mortality and population coverage of ovarian cancer from 11 cancer registration areas in Heilongjiang Province during 2018–2022 were collected. The number of cases, crude incidence rate, number of deaths, crude mortality rate, age-standardized incidence rate by Chinese population (ASIRC), age-standardized mortality rate by Chinese population (ASMRC), age-standardized incidence rate by world population (ASIRW), and age-standardized mortality rate by world population (ASMRW) were calculated for urban and rural areas respectively. The annual percentage change (APC) of incidence, mortality and age-standardized rates was calculated using Joinpoint 4.9.1.0.Results In 2022, the crude incidence of ovarian cancer in the cancer registration area of Heilongjiang Province was 9.14 / 100 000, the ASR China was 5.09 / 100 000, the crude mortality rate was 5.43 / 100 000, and the ASR China was 2.50 / 100 000. The incidence and mortality of ovarian cancer in rural areas are slightly lower than those in cities. The incidence and mortality were relatively low before 35 years old, with the highest incidence ( 16.81 / 100 000 ) in 65-69 years old and the highest mortality ( 18.51 / 100 000 ) in 80-85 years old. There was no significant difference in the trend of ASR China of ovarian cancer in the cancer registration areas of Heilongjiang Province from 2018 to 2022 AAPC = -3.81 %, 95 % CI ( -17.66 % -12.38 % ), P = 0.485 . From 2018 to 2022, the ASR China mortality rate of ovarian cancer in Heilongjiang cancer registration area decreased from 3.07 / 100 000 in 2018 to 2.50 / 100 000 in 2022, and the change trend was statistically different AAPC = -5.50 %, 95 % CI ( -9.23 % ~ -1.61 % ), P = 0.021 ..Conclusion From 2018 to 2022, the incidence of ovarian cancer in Heilongjiang Province remained stable, and the mortality rate showed a downward trend. However, in the context of the continuous deepening of population aging and the accumulation of long-term disease burden, the pressure of prevention and control of ovarian cancer still needs continuous attention. It is recommended to further strengthen the identification and health education of high-risk groups, improve the screening system in rural areas, and improve the level of early diagnosis and treatment to reduce the potential disease burden in the future.