This is an important and controversial topic. The risk of breast cancer diagnosis associated with hormone replacement therapy (HRT) is often assumed by health care professionals and the lay public alike to be very high, which may adversely influence decisions about its initiation and continuance. This is despite the fact that most women will not be diagnosed in their lifetime and any risk conferred by HRT is comparable or less than that of other postmenopausal lifestyle risk factors for breast cancer (e.g. obesity, alcohol). The impact of HRT on breast cancer diagnosis is often discussed in isolation of its benefits and there is no or little simultaneous reference to the other lifestyle risk factors for breast cancer, to provide context when counselling women about its use. This consensus statement provides an overview of the association between HRT and breast cancer outcomes in women at low and higher risk of breast cancer. It has been updated in light of a recent meta-analysis in 2019 by the Collaborative Group on Hormonal Factors in Breast Cancer (CGHFBC) and publication in 2020 of the long-term outcomes from the placebo-controlled, randomised Women’s Health Initiative study (WHI).