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Hormone replacement therapy (HRT) is traditionally contraindicated in breast cancer survivors. However, recent trends in early detection and treatment have produced larger numbers of cured women who are likely to die of non-cancer causes. They also face morbidity from menopausal symptoms and osteoporotic fractures. HRT significantly reduces the risk of cardiovascular disease and usually eliminates menopausal symptoms and osteoporosis. But HRT could degrade mammographic quality, promote development of new breast cancers or activate dormant tumor cells. Clinical trials of HRT in breast cancer survivors are beginning in order to address these important concerns.