Background: Major barriers to high risk breast cancer risk assessment include inadequate documentation of family history, complexity of risk calculation and model selection, and lack of awareness. We have established a high risk breast cancer assessment program using a computer-based real time risk calculation at time of screening mammography. Objectives were to facilitate identification of high risk patients needing genetic counseling/testing and MRI breast screening. Methods: Beginning 11/23/2010, prior to screening mammogram all patients completed a self reported risk assessment using a wireless tablet. With real time risk calculation for risk of genetic mutation (Myriad and BRCAPRO models) as well as life time risk of breast cancer (Gail, Claus, Tyrer-Cuzick, and BRCAPRO models) using HughesRiskApps patients were categorized into high risk ( ≥ 10% gene mutation risk or ≥ 20% life time breast cancer risk) or average risk groups and received a risk assessment letter. The risk data was integrated into mammography information system (Penrad) simultaneously. High risk patients were contacted by a coordinator to facilitate high risk clinic evaluation. Results: As of June 30, 2012, 24,213 patients without a cancer history completed HRA; 2,196 patients (9.1%) have been identified as high risk- for genetic mutation 1,051 pts, (4.3%), life time risk 1,570 pts, (6.5%), and both risks 425 pt, (1.8%). 416 patients (18.9%) of those high risk patients have been evaluated in the high risk clinic. 231 patients have been evaluated by genetic counselor and 97 have had genetic testing and 9 with positive results (9.3%). Yearly screening breast MRI has been recommended to 254 patients. Conclusions: We have successfully implemented breast cancer risk assessment through screening mammography service. Results suggest that 9.1% of our patients can benefit from high risk clinic assessment and 4.3% should have consideration for gene mutation testing. 6.5% of our patients may benefit from screening breast MRI. We strive to improve the number of patients who proceed with high risk clinic assessment by education of our patients regarding benefits of screening and risk reducing strategies.