Breast cancer

• Stop HRT in women diagnosed with a new breast cancer.
• Do not offer systemic HRT routinely to women with a history of breast cancer.
• A history of breast cancer should be considered a contraindication to systemic HRT. The risk of breast cancer recurrence with HRT is higher in women with ER+ve disease, but women with ER-ve disease are also considered to have an increased risk of recurrence with HRT.
• Lifestyle and non-hormonal alternatives should be offered first line, although women taking tamoxifen should not use fluoxetine, paroxetine or sertraline as they may inhibit the effect of tamoxifen.
• For further information on non-hormonal prescribable alternatives to HRT, see BMS guidance.
• See the section on menopause symptoms in the NICE Guidance on early and locally advanced breast cancer for recommendations on stopping systemic HRT in people diagnosed with breast cancer.

• HRT may, in exceptional cases, be offered to women with a history of breast cancer, where symptoms are severe and other non-hormonal modifications are not effective. This should be done after discussion with the woman, her menopause specialist and her breast /oncology team.

For information on use of vaginal oestrogen in women with a past history of breast cancer see management section.