To compare the clinico-pathologic prognostic factors and survival of younger vs older women diagnosed with epithelial ovarian cancer. Demographic, clinico-pathologic, treatment, and surgery information were obtained from patients with ovarian cancer from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001 and analysed using Kaplan-Meier estimates. Of 28 165 patients, 400 were < 30 years (very young), 11 601 were 30-60 (young), and 16 164 were > 60 (older) years of age. Of the very young, young, and older patients, 261 (65.3), 4664 (40.2%), and 3643 (22.5%) had stage I-II disease, respectively (P <0.001). Across all stages, very young women had a significant survival advantage over the young and older groups with 5-year disease-specific survival estimates at 78.8% vs 58.8 and 35.3%, respectively (P <0.001). This survival difference between the age groups persists even after adjusting for race, stage, grade, and surgical treatment. Reproductive age (16-40 years) women with stage I-II epithelial ovarian cancer who received uterine-sparing procedures had similar survivals compared to those who underwent standard surgery (93.3% vs 91.5%, P = 0.26). Younger women with epithelial ovarian cancer have a survival advantage compared to older patients. © 2006 Cancer Research UK.