How much should a family history of breast cancer in a first-degree relative influence our prescribing of HRT for early postmenopausal women?
There has been a huge amount of adverse publicity in the last few years linking HRT to an increased chance of developing breast cancer. Not surprisingly, women with a family history of breast cancer (6-19%) are often most reluctant to start on HRT. This association may be just chance, may be caused by outside factors or be genetic. However, most geneticists will not investigate women with only one first-degree relative for inherited mutations of the BRCA 1 and 2 genes. These women may or may not be at greater risk of breast cancer, which leaves the GP in a quandary. The Women’s Health Initiative (WHI) study of women taking continuous combined HRT showed an increased chance of developing the cancer of 0.8/1,000 women/year, or four extra cases for every five years of therapy per 1,000 women. This is against a background of 45 women per 1,000 getting the disease between the ages of 50 and 70. Paradoxically, the WHI study showed no increase in the incidence of breast cancer in women on oes
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