They said they feared the long-term effects or unpleasant symptoms of tamoxifen, or did not want to take medication while feeling well.
Experts estimate the 6p-a-day drug could benefit about 500,000 women in the UK.
Leeds University questioned more than 400 high-risk women. Only one in five felt strongly that they needed to take it.
Lead researcher Dr Samuel Smith said: “Some beliefs were very negative. This appears to be putting some women off tamoxifen, despite its proven ability to help prevent breast cancer.”
The study is published in the journal Clinical Breast Cancer.
Tamoxifen works by blocking hormone oestrogen. But potential side-effects include headaches, nausea and hot flushes.
A poll found only a quarter of GPs were aware of NHS guidelines saying higher-risk patients should be offered tamoxifen.
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