Background: Uptake of cancer trials and in particular prevention trials has been disappointing globally. Methods: Uptake to three randomised chemotherapy breast cancer prevention trials and two dietary prevention trials in women at increased familial risk were assessed and compared with uptake of screening trials across a range of risk categories. Results: Uptake of drug prevention trials remains low at 5.3-13.6%, but is significantly higher in the high (12%) compared to very high risk group (8.4%) for IBIS1 and IBIS2 combined (p=0.004). Recruitment to two dietary prevention studies via mail shot was also disappointingly low at 6.2% and 12.5%. In contrast uptake to two mammography screening trials was >90% in all risk categories. Conclusions: More work must be done to improve recruitment to prevention trials if they are to be seen as viable alternatives to risk reducing surgery. Impact: Trial designs and decision aids need to be developed to improve recruitment.