Approximately 200,000 women in the United Stated are diagnosed with breast cancer each year. Fifteen to twenty percent of these women will have a family history of breast and/or other cancers, and an additional five to ten percent will have a hereditary form of the disease. Family history, genetic mutations, and other factors, such as atypical cells on breast biopsy and prior radiation treatment to the chest all increase a woman's risk for breast cancer. Great strides have been made and continue to be made in the early detection and treatment of breast cancer, but it still remains the second leading cause of cancer deaths among women. Equally important to early detection and improved treatment options, is the identification and management of women who are at increased risk of developing breast cancer. Interventions can then be offered in efforts to reduce risk and ultimately prevent some breast cancers from ever occurring. Therefore, it is important for clinicians to understand the risk factors for breast cancer and know which patients should be referred for high risk evaluation and management. Components of high risk management include comprehensive risk assessment, diagnostic screening, risk reduction recommendations, referrals to additional specialists, and extensive patient education.