Although the study by Kauff et al1 suffers from a small number of cases, it does add to the literature linking the presence of a BRCA mutation, in particular BRCA1 mutations, with a small but not null risk of endometrial cancer. Of concern is many of these uterine cancers are of serous histology, which is known to harbor worse outcomes even when diagnosed with early-stage disease. Perhaps it is time to consider that the line for risk-reducing gynecologic surgery in patients with BRCA mutations not stop at the ovaries and fallopian tubes. Thus, concomitant hysterectomy with RRSO, when performed with a minimally invasive surgical approach, particularly for women with a BRCA1 mutation, should be able to be performed with minimum morbidity and allow for use of estrogen only hormone therapy after surgery, if needed. For other women (those with a BRCA2 mutation, those who would require an open laparotomy to perform hysterectomy, or those who may not require or desire hormone therapy), it may be prudent to draw the line at RRSO. Further studies are required to evaluate the true cost-effectiveness of concomitant hysterectomy with RRSO and to explore the role of risk-reducing hysterectomy in women with BRCA mutations who have already had RRSO. At the present time we would recommend that all women with a BRCA1/2 mutation undergoing RRSO should be made aware of the potential risks and benefits of a concurrent hysterectomy and of the limitations in the available studies on this issue prior to making an individualized decision.