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Use of hormone replacement therapy did not negate the reduction in risk.26 Additionally, salpingo-oophorectomy reduces the risk of ovarian or primary peritoneal cancer by 96%, but continued surveillance of these women is still recommended. Microscopic ovarian and fallopian tube cancers have been found in 2% to 10% of women undergoing prophylactic salpingo-oophorectomy, underscoring the need for careful and systematic pathologic examination of these specimens.23 At the time of surgery, the surgeon should alert the pathologist to the patient s diagnosis (BRCA1, BRCA2, etc.), so that appropriate serial sectioning and processing of the ovary and fallopian tube can be conducted (see Pathology Notes ). The surgical risks of salpingo-oophorectomy are low, but premenopausal women may suffer signi cant vasomotor symptoms from surgical menopause. 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