The US Preventive Services Task Force (USPSTF) has taken another look at the use of the anti-estrogens tamoxifen and raloxifene in the primary prevention of breast cancer in those women at highest risk. Their last comprehensive review was in 2002, at which time they endorsed the use of either of these drugs in primary prevention. This update is encouraging as it incorporates the data from the newest trials, and it shows that especially for tamoxifen the benefits are real and the side effects minimal. You can view a synopsis of the report in the April 16, 2013 issue of the Annals of Internal Medicine for free. Click here for the article. In the comments section of the article the authors make the point that this strategy is grossly underutilized and go into great detail in the body of the article as to who would be expected to derive the greatest benefit from this approach. Using the Gail model, which assigns a risk score of getting breast cancer to a woman based on well known variables such as family history and prior breast biopsy showing atypia, they show which women are likely to enjoy the greatest benefit from this approach. It is worth keeping this approach in mind if you treat women in your practice or if you are a woman with greater than average risk of getting breast cancer.