Until recently, the assessment made by the primary care provider regarding screening for breast cancer was generally limited to decisions about when to initiate mammography. Early diagnosis was stressed as the best protection against breast cancer morbidity. However, there have been recent developments in the ability to predict and modify breast cancer risk. It is therefore important for the primary care provider to be able to identify women at higher risk for breast cancer and be familiar with issues regarding screening and risk reduction. Recent data regarding the evaluation of breast cancer risk, newer screening strategies for high-risk women, and medical and surgical approaches to reduce breast cancer risk and are discussed in this article.