HRT and breast cancer risk, what to advise?

Breast cancer is the major malignancy among women in Western countries and constitutes approximately 25% of all female cancers. There is epidemiological evidence that reproductive factors and reproductive hormones are important for incidence as well as individual risk. Unfortunately the potential public health benefits of HRT have not been realised largely because of the fear of breast cancer. Epidemiological studies are conflicting but several reviews do suggest a moderately increased risk of breast cancer in long term current users of HRT. In clinical practice beneficial effects of long term HRT on women's health must be weighed against this background. The risk for adverse effects during a treatment during a period say 6-8 years is known to be very low. There is no indication for progestogen addition in women without a uterus. In most women with risk factors of osteoporosis, benefits from long term HRT apparently outweighs other possible risks. Individual asymptomatic women without any specific risk factors may well receive HRT after individual information but general recommendations for treatment of all asymptomatic women are currently not justified.