William C. Dooley, MD

The success of the National SurgicalAdjuvant Breast and BowelProject (NSABP) trial P-01at showing that we now have an effectivemeans to prevent breast cancerposes larger and more seriousquestions: Who should receivechemoprevention, and at what pointin life should this occur? The designof the P-01 study allowed many womento enroll who, according to Gailmodel calculations, were at a less than 1% per year risk of subsequent breastcancer during the expected 5-yeartreatment period. These lower-risk individualsseemed to have less benefitthan those patients at much higherrisk. Other similar prevention studiesseem to confirm this observation.