NCCN currently recommends that all women with a life expectancy of at least 10 years and a Gail risk of 1.66% or higher be counseled about the availability, benefits, and risks of breast cancer preventive therapy.10 Tamoxifen has the most data supporting its efficacy in prevention, but raloxifene and exemestane are accepted alternatives. Exemestane appears to offer the most risk reduction, followed by tamoxifen, and raloxifene but the varying toxicity profiles and individual patient risk factors should be a part of treatment decision-making.. Progress in more precisely identifying women at risk, further elucidating risk to benefit ratios, and education should make this strategy more commonly and confidently used.


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