Breast Cancer in the Family

It is not uncommon to have a family member who has had breast cancer, but does this mean your risk of developing breast cancer is higher as a result? What does an elevated risk mean for your menopause care, and is Hormone Replacement Therapy (HRT) still a suitable option for you?

You might have been informed that if you have a family history of breast cancer, you should not consider HRT. However, the available evidence does not support this notion.

The British Menopause Society concludes:

“There is no strong evidence for an additive effect of HRT upon risk of diagnosis in women at elevated personal risk due to a family history of breast cancer or personal diagnosis of a high-risk benign breast condition (i.e. lobular carcinoma in situ, atypical hyperplasia). Risk conferred by HRT will be dependent on the baseline risk in these higher risk women.”

There is no evidence from studies indicating that if you have an elevated personal risk of breast cancer due to family history, taking HRT will further increase this risk

Breast Cancer Risk

In the UK, any woman has a 1 in 7 chance of developing breast cancer during her lifetime, roughly equivalent to a 14% risk. Breast specialists consider a lifetime risk of up to 17% as within normal limits, often referred to as your ‘baseline’ risk.

This risk can increase due to factors beyond your control, such as age and family history, as well as factors influenced by your choices, such as weight and alcohol consumption.

Calculating your individual risk based on family history involves considering how many relatives were diagnosed with breast cancer, their genetic proximity to you, and their age at diagnosis.

Women with a first-degree relative (immediate family, e.g., mother, sister, daughter) diagnosed with breast cancer are identified as having a higher risk, approximately double the risk compared to those with no family history or the baseline risk. It’s essential to note that even with a first-degree relative who had breast cancer, it’s more likely that you won’t develop breast cancer yourself.

For a formal assessment of your risk level, your GP can refer you to a specialist breast or genetics clinic if you have:

  • One first-degree relative diagnosed younger than 40
  • A first-degree relative with cancer in both breasts at any age, or a male first-degree relative diagnosed at any age
  • Two first-degree relatives (or one first-degree and one second-degree) diagnosed at any age (second-degree relatives are aunts, nieces, grandmothers)
  • Three first or second-degree relatives diagnosed with breast cancer at any age
  • A first or second-degree relative diagnosed with breast cancer and a first or second-degree relative diagnosed with ovarian cancer


Your GP may also inquire about Jewish ancestry and other cancer types in your family that can elevate your risk of breast cancer. Risk levels are categorised as follows:

  • Baseline risk = up to 17% lifetime risk
  • Moderate risk = more than 17% to 30% lifetime risk
  • High risk = more than 30% to 40% lifetime risk
  • Very high risk = more than 40% lifetime risk (usually due to a genetic cause)

If you carry a breast cancer gene alteration, you are likely to be classified as having a very high risk of breast cancer. It’s important to consider both sides of your family history, as both men and women can pass on altered genes.

However, only around 5–10% of all breast cancers result from inheriting altered genes.

There are different types of altered genes, such as BRCA1 or BRCA2, as well as ATM, CHEK2, PALB2, or TP53.

Higher breast density can also increase breast cancer risk. This is more common in younger women and those with lower body fat, as they have more breast cells and connective tissue. Your genetics can also impact breast density. Having high breast density can result in up to a fourfold increase in lifetime breast cancer risk, potentially leading to increased breast screening or prophylactic (preventative) treatment.

Breast Screening with Elevated Breast Cancer Risk

If you have a moderate to high risk of breast cancer, you will typically be offered annual mammograms until age 50. Afterward, you will join the routine breast screening program every three years, which is offered to all women. If you are considered high or very high risk with a genetic link to breast cancer, you will receive care from a family history breast unit. You may also be offered MRI scans if you are under 50 and will continue to have regular mammograms until age 70.

Menopause Care with Elevated Breast Cancer Risk

To manage the risk of breast cancer and make decisions about treatment, it is essential to prioritise:

  • maintaining a healthy weight;
  • reducing or eliminating alcohol and smoking;
  • and engaging in regular physical activity.

These measures are crucial for any treatment you choose for menopause symptoms and for reducing breast cancer risk.

HRT is the most effective treatment for menopause symptoms and provides long-term health benefits like reducing the risk of osteoporosis and cardiovascular disease. Despite a family history of breast cancer, there is no strong evidence to suggest that HRT increases breast cancer risk beyond your existing level.

HRT typically includes oestrogen and progesterone (if you have a uterus) and may also include testosterone. Micronised progesterone, known as ‘Utrogestan’ in the UK, is considered the most ‘breast-friendly’ progesterone component of HRT, with no known associations with an increased risk of breast cancer.

The dose of oestrogen is not linked to an elevated risk of breast cancer, and decisions regarding estrogen dosage depend on symptom management and individual response.

If you require only oestrogen (usually after a hysterectomy), taking HRT may actually lower your breast cancer risk.

For genitourinary symptoms of menopause like vaginal dryness or pain during intercourse, safe treatments in the form of vaginal hormone medications are available, which do not enter the bloodstream and are suitable even for those with a history of breast cancer.

There is a wealth of information available about HRT and breast cancer, which can sometimes be confusing or contradictory. To decide the best approach for your menopause symptoms, assess their impact on your life, gather information on different HRT types from reliable sources, understand your personal breast cancer risk, and discuss your options with a knowledgeable healthcare professional.

If your regular doctor is hesitant to prescribe HRT due to your family history, seek another doctor with menopause expertise. Your healthcare provider should explain the implications of all treatment options and help you make a decision that aligns with your needs and preferences.

Remember that maintaining a healthy lifestyle, including a healthy weight, reducing alcohol intake, and staying physically active, are key measures for reducing breast cancer risk.

If you have been identified as having a high risk of developing breast cancer because of your family history, you might find this information helpful: