Regarding the NICE 2015 guideline on menopause management, which statement about hormone replacement therapy (HRT) and breast cancer risk is most accurate?

• A Combined estrogen-progestogen HRT for 5 years in women aged 50–59 carries a risk equivalent to drinking two units of alcohol per day
• B HRT with micronized progesterone has been shown to have no increased breast cancer risk compared to synthetic progestogens in the E3N cohort study ✓
• C Estrogen-only HRT in women with intact uterus increases endometrial cancer risk without breast cancer benefit
• D All forms of HRT including vaginal estrogen are contraindicated in women with prior breast cancer

Explanation

The E3N cohort study (French observational study) showed that combined estradiol plus micronized progesterone was not associated with increased breast cancer risk (RR approximately 1.0), unlike estradiol combined with synthetic progestogens (norethisterone, MPA) which significantly increased risk. This evidence underpins the current preference for body-identical/micronized progesterone in HRT regimens. NICE 2015 guidelines incorporate this distinction. Vaginal estrogen (topical, low-dose) is considered safe even in breast cancer survivors for genitourinary syndrome of menopause by most guidelines (though oncologist consultation is advised).

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.