It is very common to have a relative who has had breast cancer but does this mean you have a higher risk of developing breast cancer as a result?
What does a raised risk mean for your menopause care and is HRT still a suitable option for you?
You may have been told that because you have a family history of breast cancer you should not take HRT.
This booklet explains the different levels of breast cancer risk and outlines what the evidence says about taking HRT with an elevated risk of breast cancer.
Risk of breast cancer
Any woman in the UK has a 1 in 7 chance of developing breast cancer over the course of her lifetime. This equates to around a 14% risk but breast specialists consider up to 17% lifetime risk as within normal limits – also known as your ‘baseline’ risk.
This risk increases with some factors that you can’t change, like your age and family history, and other factors that you can influence like your weight and alcohol intake.
Calculating your individual risk level from your family history is based on how many relatives were diagnosed with breast cancer, how genetically close they are to you, and what age they were when they were diagnosed.
Levels of risk according to family history
Women who have a first degree relative (those in the immediate family e.g. mother, sister, daughter) diagnosed with breast cancer are identified as having a higher risk, and this is approximately double the risk of those with no family history or the baseline risk.
It’s important to remember that even if a first degree relative had breast cancer it is more likely that you’ll never go on to develop breast cancer yourself.
If you want your own level of risk assessed formally, your GP can refer you to a specialist breast or genetics clinic if you have:
- One first degree relative that was younger than 40 when diagnosed
- 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 ask you if you have any Jewish ancestry and some other questions regarding types of other cancers in your family that also raise your risk of breast cancer.
To help you and your healthcare professionals manage your level of breast cancer risk and make decisions about treatment, the levels of risk are identified as followed:
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 those with a genetic cause)
Inherited breast cancers
You are likely to be identified as having a very high risk of breast cancer if you’re found to carry a breast cancer gene alteration. Both men and women can pass on the altered genes so it is important to consider both sides of your family history when thinking about your relatives.
Only around 5–10% of all breast cancers are due to having inherited an altered gene.
There are different types of altered genes that raise your risk of breast cancer. You may have heard of BRCA1 or BRCA2, and there are other types such as ATM, CHEK2, PALB2, or TP53.
If you have been identified as having a high risk of developing breast cancer due to your family history, you may find this information useful:
A Beginner’s Guide to BRCA1 and BRCA2
Breast Cancer Now’s information on family history of breast cancer
Breast density
Breast cancer risk can also be higher if you have more dense breast tissue. This is more commonly found in younger women and those with less body fat who have more breast cells and connective tissue in their breasts. Your genes can also affect your breast density.
There can be up to a x4 increase in lifetime risk of developing breast cancer if you have high breast density and because of this, you may be offered increased breast screening.
In some cases, a prophylactic (preventative) treatment such as Tamoxifen may be offered, but many women find such medications bring about unpleasant side effects and they may decide not to take the treatment. They then choose to live with the (usually small) increased risk their breast density poses and incorporate healthy lifestyle measures to keep their general risk of breast cancer as low as possible.
Breast screening when there is an elevated risk of breast cancer
If you have been identified as having a moderate to high risk of breast cancer, you will be offered annual mammograms until you turn 50. You will then be discharged from the breast clinic and join the routine breast screening programme offered to all women, which is a mammogram every 3 years.
If you are considered high or very high risk and have a genetic link to breast cancer, you will usually be cared for by a family history breast unit and offered imaging such as MRI scans if you’re under 50 years, and then have regular mammograms until you are 70 years.
Menopause care if you have an elevated risk of breast cancer
As with managing the risk of many health conditions, it is important to prioritise , to reduce or cut out alcohol and smoking, and be physically active on a regular basis. These measures are essential building blocks for any further treatment you choose to take for your menopause symptoms and for reducing your risk of breast cancer in the future.
It’s important to understand what your options are if you’re experiencing unwanted symptoms of the perimenopause or menopause. HRT is the most effective treatment for symptoms and it provides protective health benefits for the future such as reducing your risk of osteoporosis (a bone weakening disease) and cardiovascular disease.
You may have been told that you cannot take HRT if you have a family history of breast cancer, but this is not what the evidence suggests.
The British Menopause Society concludes:
“Overall, 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.”
No studies have shown that if you have a raised personal risk of breast cancer because of family history that taking HRT raises this risk further.
Types and doses of hormone replacement treatments
HRT usually includes estrogen and progesterone (if you still have your womb), and it may or may not include testosterone as well.
Click on these links if you’d like to read more about HRT in general or the different types of HRT.
The progesterone component of HRT that is considered the most ‘breast-friendly’ according to the evidence, is micronised progesterone. This is body identical and is branded as ‘Utrogestan’ or ‘Gepretix’, and is also available as generic micronised progesterone in the UK. There are no known associations with these medications and an increase in breast cancer risk for up to 5 years of use.
You may be wondering whether the dose of estrogen will affect your risk of breast cancer. You can be reassured that as there is no increased risk from taking HRT with a family history of breast cancer, the dose of estrogen does not influence this further. Decisions about your dose of estrogen are primarily based on how your body is responding to the treatment and how well your symptoms are managed.
If you only need to take estrogen (usually because you’ve had a hysterectomy) the evidence suggests taking HRT will actually lower your risk of getting breast cancer.
If you have genito-urinary symptoms of menopause like vaginal dryness, urinary tract infections, or pain on sexual intercourse, there are effective treatments in the form of vaginal hormone medications. Unlike systemic HRT, the hormones in these vaginal treatments do not get absorbed into the bloodstream and are very safe to take long term, including if you have already had breast cancer.
Deciding what’s right for you
There is a lot of information available these days about HRT and breast cancer, and it can be confusing or even contradictory at times. It can be difficult to know what’s best to do about your menopause symptoms and not all healthcare professionals are fully up to date regarding the latest types of HRT or what the evidence says about associated risks.
Consider your symptoms and the impact they are having on your life, find out about the different types of HRT from reputable sources, understand your personal risk of breast cancer and what the evidence says about taking HRT, and discuss it with a knowledgeable healthcare professional. If you think you’d like to try HRT, it is best to start it as soon as you’re having symptoms and not wait for things to get worse.
If you have a family history of breast cancer, you should usually have all menopause treatment options open to you including HRT, as there is no evidence that HRT will raise your risk above the level you already have.
If your usual doctor will not prescribe HRT for you because of your family history, try and see a different doctor with menopause expertise. Your health professional should explain the implications of all your treatment options and support you to make a decision that’s right for you.
Remember, the most important measures to take to reduce your risk of breast cancer are to maintain a healthy body weight, cut down or cut out alcohol, and exercise regularly.
Dr Alison Macbeth
Last updated: June 2026
