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Breast cancer risk is increased among users of injectable contraceptives in some studies,[1,2] while other studies show no association.[3-5] Breast cancer risk does not appear to be increased among users of contraceptive implants. Current use of combined oestrogen-progestogen hormone replacement therapy (HRT) for menopausal symptoms is classified by the International Agency for Research on Cancer (IARC) as a cause of breast cancer, and use of oestrogen-only HRT is classified as a possible cause of breast cancer. An estimated 3% of female breast cancers in the UK are linked to HRT use. HRT contains synthetic sex hormones, which may explain the link between HRT use and breast cancer risk.
Breast cancer risk is 55-100% higher in oestrogen-progestogen HRT (combined HRT) current users versus never users, cohort studies have shown.[3,4] Breast cancer risk is also higher in oestrogen-only HRT users, though to a lesser extent than with combined HRT, cohort studies have shown.[3,5-9] Breast cancer risk is not associated with past HRT use 5 years or longer ago, cohort studies have shown.[3,10] Breast cancer risk among current HRT users increases with duration of use, and with lower body mass index (BMI).[3,10,5-9] Breast cancer risk among HRT users may vary with previous use of OCs, but evidence remains unclear.[11-13] Breast cancer risk does not appear to be increased by use of phytoestrogens (plant-derived chemicals used by some women as an alternative to HRT), a meta-analysis showed; however the efficacy of phytoestrogens for relieving menopausal symptoms remains unclear. Hereditary factors explain only around a quarter of breast cancer risk. Breast cancer risk is not associated with breast cancer in an adoptive parent, and does not vary with time since the family member was diagnosed, indicating genetic/biological factors or increased diagnostic activity rather than environmental factors underpin familial clustering of breast cancer cases.[2,3] Breast cancer risk is around twice higher in women with one first-degree relative with breast cancer, versus women with no first-degree relatives with the disease, meta- and pooled-analyses have shown.[1,2] The risk is higher still with a larger number of affected first-degree relatives, or relatives affected aged under 50.[1,2] ER-positive or ER-negative breast cancer risk are associated to a similar extent with family history. Over 85% of women with a first-degree relative with breast cancer will never develop breast cancer themselves. 87% of women with breast cancer have no first-degree relatives with the disease. BRCA1 and BRCA2 mutations confer a high risk of breast cancer in carriers (high-penetrance).