Evans et al publish figures again showing disappointingly  low recruitment rates of women at high risk of breast cancer to prevention trials. Of 4359 women invited to 5 different drug or dietary prevention trials only 5-13% decided to join the study concerned. In contrast uptake to two mammography screening trials was >95%. If we are to develop realistic alternatives to risk reducing surgery more high risk women need to be recruited to prevention trials. (By Professor D Gareth Evans, http://jmg.bmj.com/content/early/2010/10/23/jmg.2010.082768.abstract?papetoc )