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We thank Dr. Wood and colleagues for their interest in our article.1 We read with interest their proposal for a study involving more intensive surveillance. There is still uncertainty about the lifetime risk of endometrial and epithelial ovarian malignancies in female hereditary nonpolyposis colorectal carcinoma (HNPCC) gene carriers. This uncertainty has implications regarding both the potential benefit derived from surveillance and the number of individuals required for a study comparing different modes of surveillance. Any future studies of the role of surveillance in the prevention of endometrial and epithelial ovarian malignancies in patients with HNPCC should involve known gene carriers. The ability to reliably define premalignant changes on endometrial biopsy clearly would have great potential benefits, and the study performed by Kremer et al.2 on the acceptability of and patient satisfaction with outpatient hysteroscopy and endometrial biopsy is pertinent. Nonetheless, careful power calculations are required before any future studies are undertaken, and it would be important to establish that annual outpatient hysteroscopy and endometrial biopsy are similarly well tolerated by patients at nonspecialist centers and do not adversely affect patient compliance. A large European study (the Prevention of Hereditary Endometrial Cancer study) is being prepared, and interested specialists are invited to contact Dr. Hans F.A. Vasen (e-mail address, [email protected]).