Is removal of ovaries a must for woman with low cancer risk?

Dear Dr. Roach: I am a 66-yearold post-menopausal woman who is scheduled next month for a hysterectomy to correct a pelvic organ prolapse. There is no history of ovarian cancer in my family. My first period was at age 12, and menopause happened for me at age 51. I used birth control pills.

My gynecologist is leaving the decision up to me. I have read that ovaries produce important hormones after menopause. What are your thoughts on keeping my ovaries?

D.F.

I recommend prophylactically removing the ovaries during a hysterectomy only when a woman is at a high risk for ovarian cancer. You haven’t identified any risk factors for ovarian cancer. You don’t have early menarche (first period before age 12) or late menopause (age 55 or greater), both of which increase the risk.

Having taken birth control pills or having children decreases the risk of ovarian cancer. Since the lifetime risk of ovarian cancer in an average risk woman is just over one per cent, your risk is going to be below this, and there is not a large benefit in removing your ovaries from this standpoint.

Removing the ovaries greatly reduces ovarian cancer risk (by more than 90 per cent), but does not eliminate it entirely. This is because there are additional tissues, which contain the same cells that turn into ovarian cancer. In younger women, removing the ovaries reduces breast cancer risk, but there is no proven benefit in women over 60.

However, there is proven harm from removing the ovaries, apart from the small risk during surgery. Women who undergo this procedure are at a higher risk for heart disease and overall death, as well as chronic kidney disease. But these risks were found primarily in women who were younger than you at the time of surgery.

For women at an average risk of ovarian cancer, the best data we have suggest that removal of the ovaries doesn’t provide a net benefit for menopausal women and probably causes net harm to younger women.

In a recent Mayo Clinic study, only 2.5 per cent of women had elective removal of their ovaries at the time of a hysterectomy. Women with a high risk of ovarian cancer, such as those with a strong family history or who are known to have a genetic predisposition (such as the BRCA1 or BRCA2 genes), should discuss options with a genetic counsellor.

Dear Dr. Roach: I don’t remember anyone having peanut allergies in the 1960s and ’70s when I was in school. Now it seems peanut allergies are everywhere. What changed? Are peanuts different, or are people?

S.S.

Peanut allergies have increased in recent years, with 0.4 per cent of people reported in 1997; 0.8 per cent in 2002; and 1.4 per cent in 2008. The most recent data remain between one and two per cent. The exact reason why isn’t clear, but it’s not because peanuts are different.

From my reading, the most likely answer is that kids aren’t getting exposed to peanuts at a very young age, which protects against the development of a peanut allergy. However, attempts to increase peanut exposure to infants were not successful at reducing peanut allergies in a trial in Australia.