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HRT
14 mins

HRT, breast cancer and your family history

byDr. Lucy Wilkinson

Breast cancer is a common but often treatable form of cancer. Scientists used to think HRT increased breast cancer risk, but this research is viewed differently now. What does this mean if you want to take HRT and have a family history of the disease? What can lower your risk? Read our guide to HRT and breast cancer for the answers to all these questions and more. 

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Breast cancer basics

Cancer is the uncontrolled growth of cells, which may then go on to spread – or metastasise – around your body. Breast cancer starts in your breast tissue. 

One in seven women in the UK get breast cancer in their lifetime and your risk increases as you age. Men can get breast cancer too, but it is far less common.

Breast cancer is a serious illness but treatments are improving all the time. It can be treated especially well if it’s caught early. Almost everyone who finds breast cancer at the earliest stage can expect to live five years or more.

When doctors talk about the ‘stage’ of a cancer, they mean the amount that the cancer has spread from the original tumour. This ranges from stage one (no spread) to stage four. Stage four means widespread cancer, for example with spread to the lungs, bones or liver. 

What are the risk factors for breast cancer?

Certain things can increase your risk of breast cancer, such as:

  • Your weight – a Body Mass Index (BMI) over 25 puts you at a higher risk of breast cancer
  • How much alcohol you drink
  • If you take a contraceptive pill
  • Some forms of HRT. Read on to find out more

What does this mean for you? You can lower your breast cancer risk by making changes to your lifestyle and managing your weight.

There are other risk factors that you can’t do anything about, such as:

  • Your family history
  • Your age
  • Your age when your periods began
  • Your age at menopause
  • Having dense breast tissue or breast lumps that are not cancerous, also known as benign breast lumps

A breast cancer risk calculator can give you an idea of your personal risk of breast cancer.

Does HRT increase your risk of breast cancer?

You may have heard that HRT is linked to increased breast cancer risk. This view was once widespread due to research findings in the 1990s and early 2000s. However, scientists look at that research differently today. Those original studies are widely thought to have overestimated the risks of HRT as:

  • They focused on a limited number of older HRT preparations and 
  • They included older (and therefore higher-risk) women than those who typically take HRT today

Since then, research has examined the risks of HRT in more detail, revealing a much lower risk than previously thought. Newer HRT options also seem to have lower risks than those reviewed in previous studies.

However, the risk hasn’t disappeared. Some types of HRT do increase your risk of breast cancer and the risk increases the longer you take it. Despite this, the risks are small when compared with other risk factors. For example, taking HRT increases your risk by the same amount, or even less than, being overweight or drinking alcohol. 

Let’s take a look at some of the different types of HRT and their risks.

Combined HRT – oestrogen and progesterone

Current research suggests that 23 out of 1,000 women aged 50-59 will develop breast cancer within five years. This is the baseline risk.

If the same 1,000 women take combined HRT – oestrogen and progesterone – 27 of them will develop breast cancer. This is four more than the baseline risk – a 17% increase in risk.

How does this compare to lifestyle-based risk? There would be:

  • Five extra cases per 1,000 women if they all drank two or more units of alcohol per day – that’s about a pint or glass of wine a day
  • 24 extra cases per 1,000 if all of the women were overweight or obese. This more than doubles the risk

Oestrogen-only HRT

Oestrogen-only HRT may decrease your risk of breast cancer. Current figures suggest 19 cases of breast cancer per 1,000 women over five years. This is four fewer cases than the baseline risk, or if the women did not take oestrogen-only HRT. 

Your risk

Think about your overall health if you are concerned about your risk of breast cancer with HRT. You might be uncomfortable with the extra risk of combined HRT if you are at higher risk of breast cancer already and your symptoms are mild. Others think the small increased risk is reasonable if taking HRT treats menopause symptoms that disrupt daily life.

Your risk after you stop taking HRT

Your increased risk of breast cancer from taking HRT gradually gets lower after you stop taking it. 

Can you take HRT if you have a family history of breast cancer?

HRT may be suitable if you have a family history of breast cancer, but this is complex and you need to speak to your doctor for advice. They may refer you to a menopause specialist or breast cancer specialist.

Current guidance recommends that you can take HRT with a family history of breast cancer if:

  • You and your doctor have carefully weighed up the risks and benefits
  • You and your doctor decided that the benefits outweigh the risks
  • You take HRT for the shortest amount of time needed to control your symptoms – the risk increases the longer you take it
  • You take as low a dose of HRT as possible
  • You take oestrogen-only HRT if you don’t have a womb
  • You are under 50 if your risk level is moderate-high

There are other, non-hormonal options you could try too, such as:

  • Non-hormonal medication
  • Lifestyle change, such as managing your weight, increasing your exercise levels or getting more sleep 

We share more about these later.

Can you take HRT if you’ve had breast cancer before?

You should usually avoid HRT if you’ve had breast cancer in the past according to current guidance, but there may be rare circumstances when it is still recommended.

Speak to your doctor for advice if you have a history of breast cancer and are struggling with menopause symptoms 

Your doctor will likely refer you to a breast surgeon or oncologist – a doctor specialising in cancer.

Can you take HRT if you have other breast cancer risk factors?

You can take HRT if you have risk factors for breast cancer. But you will only get a prescription for HRT if the possible benefits outweigh the possible risks. See your doctor for advice.

Read more about the benefits and risks of HRT. 

How can you treat your menopause symptoms if you can’t have HRT?

There are many non-hormonal treatments for menopause symptoms that have been proven to work.

Hot flushes

Non-hormonal medications that can help menopausal symptoms including hot flushes include:

  • SSRI antidepressants, such as sertraline, citalopram or fluoxetine
  • Clonidine
  • Gabapentin

Other non-hormonal treatments for hot flushes are in development. A new medication known as Fezolinetant (Veoza) is now available in the UK on private prescription. 

Bladder and vaginal problems

If you are struggling with urinary or vaginal symptoms of menopause, non-hormonal options are available. These include:

  • Vaginal moisturisers. These are widely available to help vaginal dryness or painful sex
  • Lubricants. Try a pH-balanced lubricant to relieve painful sex, such as YES Water-Based Lubricant

Vaginal oestrogen might also be suitable for you, even if other types of HRT are not. These are low dose and generally much lower risk products such as vaginal gels, creams and pessaries. Ask your doctor if you think this might be an option.

Other symptoms

Lifestyle changes are thought to help with lots of symptoms, from sleep issues to anxiety and low mood. These include:

  • Getting enough exercise
  • Maintaining a healthy weight
  • Eating a nutritious diet
  • Rethinking your caffeine, alcohol and nicotine intake

Don’t be overwhelmed by this list! Start small. Little changes can make a big difference. For ideas on how to increase how much you move, read our blog on the best exercise for menopause. 

What should you do if you’re on HRT and develop breast cancer?

Current guidance advises stopping HRT if you are diagnosed with breast cancer. This is because some cancers are affected by hormones, and may even grow more quickly when oestrogen is present. These are known as hormone-dependent tumours.

Speak to your doctor as soon as possible if you are on HRT and find any breast changes – just as you would normally.

How to check your breasts

Check your breasts and chest regularly to help pick up on any changes or lumps as soon as possible. Once a month is a good guide. 

Try to do it at the same time each month, and avoid checking them when you’re on your period if you still have periods. Not sure you’ll remember? You can set up a monthly text reminder.

The shower or bath is a common place to do this, as soap makes it easier to run your hands over your breasts. Make sure to:

  • Feel your chest, both breasts and armpits. You’re looking for any changes. This includes lumps, thickenings, sore areas or changes in texture
  • Look at your breasts in the mirror. Look out for any rashes, dimples, puckering, orange-peel appearance and changes to size or shape. 

Sometimes changes are obvious, but other times you may be unsure. Be aware that breast cancer can sometimes show up in surprising ways. If you notice anything different about your body – particularly if you’ve previously had breast cancer – see your doctor. Less common but important things to look out for are neck lumps, back pain, breathing difficulties and unexplained weight loss. While these are more commonly signs of other conditions, they can be associated with breast cancer too and should be checked out by a doctor.

Your doctor may then refer you to a breast clinic. You can expect to be seen within two weeks. You are likely to see a specialist at the breast clinic and have a scan or mammogram, which is an X-ray picture of your breast. A small sample of breast tissue may be taken if a lump is found. This is called a biopsy and your doctor will explain how exactly this will happen, as there are many methods.

Mammograms

You will be invited for a regular breast screening from age 50 onwards. These may start earlier if you are at higher risk of breast cancer. 

At your breast screening, you will have a mammogram. These are done every three years to pick up early signs of breast cancer. If any changes are found on your mammogram, you will be referred for further assessment.

From age 71 you will not be invited for regular mammograms, but you can still request them.

Read more about essential health screenings.

Early screening

You may be invited for an early breast cancer screening before age 50 if you are at higher risk of developing breast cancer. Check if this applies to you, as it doesn’t always happen automatically. 

Speak to your doctor for advice if you have a family history of breast cancer. Current guidelines recommend that some people with a family history should be referred for further advice and earlier screening, although it can be complicated to decide if this applies to you. 

Final word

HRT can contribute to the risk of breast cancer but this risk is small and doesn’t outweigh the potential benefits for most people. It’s important to discuss your menopause treatment with your doctor, especially if you have had breast cancer, have a family history or are at higher risk for another reason. Arrange an appointment to review your treatment if any of these circumstances have changed recently.

And don’t forget to pop your next breast self-check and breast screening in your calendar. This is one piece of self-care that you shouldn’t skip or put off!

Find out more about menopause on our blog or in our symptoms library.

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Our author

Dr. Lucy Wilkinson

Dr. Lucy Wilkinson is a general practitioner with special interests in women’s health and digital health. She trained at the universities of St Andrews, Manchester, and the Autonoma University of Madrid, and holds postgraduate qualifications in obstetrics, gynecology and sexual health. She is a member of the British Menopause Society and clinical advisor at Stella.

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