How to Prescribe MHT According to the Risk of Breast Cancer

Breast cancer is the primary cancer in women in most countries in the world. It is a constant fear to increase the risk in the context of any hormonal treatment prescribed by physicians and used by women. Despite the fact that breast cancer is in most cases a hormone-dependent cancer, the possible increase in risk related to menopause hormonal treatment (MHT) is not as great, is associated with duration, is less important with estrogen treatment alone than combined estrogen/progestin treatment, can be limited by certain preparations, and in a majority of studies, is not associated with increases in mortality, and in some cases, a decrease in mortality is seen. Nevertheless, it is important to select patients according their own risk of breast cancer before making the decision for any hormonal administration and evaluate the benefit/risk ratio. Breast cancer is multifactorial and combines genetic and environmental factors. Some scores exist and help to evaluate the range of the life risk for a given woman even though they are not very precise in predicting the risk. If a genetic cause cannot be modified, some lifestyle modifications could help to decrease the relative risk of breast cancer. We will review the evidence concerning the risk factors for breast cancer, the management of women with moderate to high risk, and discuss the role of a chemical prevention in these patients.