Breast cancer cutoffs for counseling before recommending MHT

Risk category*	5-year NCI or IBIS breast cancer risk assessment (%)	Suggested approach
Low	<1.67	MHT ok
Intermediate	1.67 to 5	Caution^¶
High	>5	Avoid

MHT: menopausal hormone therapy; NCI: National Cancer Institute; IBIS: International Breast Intervention Study.

* Categories here are newly defined for these guidelines and based on recommendations published for use of antiestrogens for breast cancer prevention. The assumption is that candidates for breast cancer prevention with antiestrogens should not be candidates for initiating MHT. Method to calculate risk varies among countries.

¶ Caution indicates need for detailed counseling regarding anticipated benefits and risks of MHT with strong consideration of nonhormonal therapies for symptom relief, and possible consideration of chemopreventive strategies for females who meet suggested criteria.

Republished with permission of The Endocrine Society, from Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2015; 100:3975. Copyright © 2015; permission conveyed through Copyright Clearance Center, Inc.

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Breast cancer cutoffs for counseling before recommending MHT