How to assess breast cancer risk in menopausal patients being treated with menopausal hormone therapy?

The administration of Menopausal Hormone Therapy (MHT) needs to be evaluated in relation to the individual patient’s indications for therapy and risk estimations, which include the Breast Cancer (BC) risk estimation. We reviewed the lifetime BC risk and the associated mortality in relation to MHT use. For many patients with climacteric symptoms and/or osteoporosis, the balance is in favor of MHT use. The risk of breast cancer can be estimated using unmodifiable risk factors, such as the patient’s personal and family history, the breast density assessed on her mammogram, and modifiable risk factors such as alcohol intake. In complex situations, prediction models can be used to guide decision-making. When the 5-year BC risk is low (below 3%), MHT can be prescribed; caution is needed in women with a risk between 3% and 6%, and MHT should generally be avoided when the risk is high, i.e. above 6%.