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Women who carry BRCA1 or BRCA2 mutations have a significantly elevated lifetime risk for developing breast cancer and ovarian cancer. The risk is reduced by >90% with bilateral mastectomy and by 50% with premenopausal bilateral salpingo-oophorectomy. Data demonstrating the benefit of nonsurgical risk-reduction strategies have been less compelling. Large prevention trials with tamoxifen have clearly demonstrated that risk can be reduced by 40% to 50% in at-risk women, though not necessarily in mutation carriers, yet uptake of tamoxifen for prevention has been disappointing. One prospective trial in the primary-prevention setting (JAMA 2001; 286:2251) suggested that tamoxifen reduced the risk in BRCA2 carriers (hazard ratio, 0.38) and increas…