@laura1970 you are right that Duavee still carries a boxed warning - it highlights endometrial cancer, cardiovascular events, and probable dementia while not listing breast cancer specifically.

Long term data on Duavee are limited, however, short term studies haven't shown an increased breast cancer signal. In fact there are some favorable changes in breast cancer biomarkers. For someone with a positive family history but no personal history and with negative BRCA 1&2 testing, I think it's worth discussing her option with an obgyn who is familiar with breast cancer risk assessment or a breast oncologist. They can decide whether Duavee, standard HRT/MHT, or other approach (even no therapy) best fits her goal for slowing bone loss as well as postmenopausal symptom relief.