How do you counsel patients with BRCA-1 mutations regarding the role of hysterectomy as a part of risk-reducing surgery?

I routinely offer hysterectomy at the time of risk reducing BSO for BRCA1 mutations. There is an approximate ~3% risk of serous uterine cancers in these patients (Uterine Cancer After Risk-Reducing Salpingo-oophorectomy Without Hysterectomy in Women With BRCA Mutations). Additionally, in patients who either have not had an ER+ breast cancer or bilateral mastectomy, hysterectomy simplifies HRT with an estrogen alone option for vasomotor symptoms.

I discussed the advantages and disadvantages of hysterectomy as part of risk reducing surgery. There is evidence that patients with BRCA1 mutations are at slightly higher risk of papillary serous endometrial cancer.

Hysterectomy simplifies post-operative hormone replacement therapy.

For patients that have risk factors for endometrial hyperplasia or cancer, I recommend a hysterectomy.