Thousands of women across Britain with a family history of breast cancer are to be offered drugs on the NHS to help prevent the disease.
The National Institute for Health and Care Excellence says tamoxifen or raloxifene taken daily for five years can cut breast cancer risk by 40%.
Its guidance for England and Wales means 500,000 women now have a choice other than mastectomy.
The Scottish government says it will offer tamoxifen to women at risk.
However, experts say women still need to carefully weigh up their options.
One in every five breast cancers has a family link.
Having close relatives - a mother, sister or aunt - with breast cancer increases a woman's chance of getting the disease, as does inheriting certain genes such as BRCA1 and BRCA2.
Hollywood actress Angelina Jolie revealed last month that she had undergone a preventative double mastectomy to cut her own chance of developing breast cancer because she carries one of these risky genes.
Risk reductionThe new guidelines from NICE are the first in Europe to recommend that healthy women are given drugs to prevent breast cancer. It is likely that Northern Ireland will soon follow suit.
The Scottish government says women with two or more family members who have had breast cancer will be offered the treatment for five years.
- Women in general have a 1-in-8 chance of developing breast cancer
- But some are at higher risk than this because of their family history
- Having a mother or sister diagnosed with breast cancer doubles your risk of breast cancer, for example
- If several members of your family have had particular types of cancer, or if a relative was diagnosed with breast cancer at a young age, your risk of developing breast cancer may be increased further
- Moderate risk means you have at least a 1-in-6 risk of getting breast cancer by the end of your life, while high risk means you have a 3-in-10 risk
- Inherited genes - like BRCA1 and BRAC2 - increase your lifetime risk by up to 90%
- Most breast cancers have no family link
It was announced last month that genetic testing was also to be offered in Scotland to those with a 10% risk of a faulty gene.
NICE says women in England and Wales who are aged over 35 and at "moderate" or "high" risk of breast cancer as a result of their family history or genes should be considered for preventative drug therapy.
By this they mean women with at least a one in six chance of developing the disease.
The Welsh government said it welcomed the updated guidance and expected local health boards to make the drugs "available to patients who meet the clinical criteria".
Taking a tamoxifen or raloxifene tablet every day for five years could nearly halve their breast cancer risk and this protective effect should last for at least a decade, studies suggest.
While this sounds like a good and simple choice, experts say women need to carefully weigh up their options.
Surgery to remove both breasts would bring a woman's lifetime risk down to virtually zero.
And tamoxifen can be unpleasant to take, causing side-effects such as hot flushes and blood clots.
Up to half of breast cancer patients prescribed the drug as a treatment for their tumour give up taking it, research suggests.
'Leap forward'Wendy Watson chose to have a preventative double mastectomy at the age of 37 because she knew of nine relatives who had breast cancer.
Ms Watson, who runs a helpline for those at high risk of breast cancer, told BBC Breakfast she received many calls from people who "don't quite fit the criteria and yet they know they've got a huge family history but they can't get a genetic test".
"So this lowering of the threshold is one of the most exciting bits to me."
Dr Andrew Cuthbert, who has previously worked on guidelines for the institute, said tamoxifen was "a very inexpensive drug".
"I believe the cost of an annual treatment is a matter of a few hundred pounds," he told BBC News.
"That's very much cheaper than some of the cancer drugs we hear about - which are tens of thousands of pounds for a course of treatment - and it's taken for five years only but the reduction in risk is very long-lasting."
NICE said the decision about the best treatment should be a joint one between the patient and the medical team.
Dr Caitlin Palframan, of Breakthrough Breast Cancer, said the guidelines were a game-changer.
"Our strongest tool in the fight against breast cancer is prevention, and these new guidelines are a fantastic leap forward in the way we prevent breast cancer developing in those at highest risk," she said.
Sean Duffy, national clinical director for cancer at NHS England, said: "It is earth-shattering for women who find out they are at high risk of developing breast or ovarian cancer.
"As a health service, it's our duty to provide the best possible evidence-based advice on the options that are available, focusing on the patient's personal circumstances.
"[The NICE guidance] adds a further dimension to the options available for women who are at risk of developing ovarian and breast cancer."
Breast cancer is the most common cancer in the UK, with about 50,000 women and 400 men diagnosed with the condition each year.
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