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For North American physicians, the most familiar trial of tamoxifen as a preventive agent in women at high risk for breast cancer is probably the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1. Participants were randomized to 5 years of daily tamoxifen or placebo; after a median 54-month follow-up, the tamoxifen group had a 49% relative reduction in incidence of invasive breast cancer, although the effect was specific for estrogen-receptor (ER)-positive breast cancer (J Natl Cancer Inst 1998; 90:1371). Despite the impressive results of the P-1 trial, tamoxifen use in the population that is eligible to receive it as a chemopreventive therapy has remained low. Explanations for the dismal adoption of tamoxifen as a chemopreven…