Background: Despite FDA approval of medications for breast cancer risk reduction and professional organizations’ (ASCO, USPSTF & NCCN) chemoprevention recommendations, chemoprevention use has not increased substantially. Barriers and facilitators to primary care providers’ (PCP) incorporation of breast cancer chemoprevention could inform efforts to increase uptake. Methods: We conducted an online survey of PCPs’ regarding awareness and use of breast cancer chemoprevention, and perceived barriers/solutions. All eligible PCPs at Geisinger Health System (family physicians, internists, residents, physician assistants, nurse practitioners) who practice ≥ one-half day per week in a family practice, internal medicine or OB-GYN outpatient clinic were invited to participate via email (four attempts total). Results: Of 492 invited providers, 195 (40%) participated (mean age 41 years, 61% female, 70% MD/DO, 45% ≥ 10 years in practice). Of the 195 participants, 74 (38%) used the Gail model for breast cancer risk assessment and 16 (8%) used Tamoxifen or Raloxifene for breast cancer prevention in the past year. Providers who used the Gail model were more likely to have made a breast cancer diagnosis in the past year (72% vs. 53%; p = .01). Providers who ever prescribed chemoprevention were older (mean age 49 vs. 40 years), were more likely to be in practice ≥ 10 years (75% vs 42%; p = .03), and to have diagnosed breast cancer in the past year (100% vs. 57%; p = .001). Barriers to incorporating breast cancer chemoprevention in primary care most commonly reported were lack of knowledge about chemoprevention drugs (75%), unaware of chemoprevention guidelines (67%), and inability to identify high risk women (62%). Only 41% perceived time constraints as a barrier. If risk assessment tools could be integrated to facilitate identification of high risk women, PCPs (85%) prefer referring appropriate women to a high-risk breast clinic to managing breast cancer prevention themselves. Conclusions: PCPs infrequently assess breast cancer risk and rarely prescribe chemoprevention drugs for risk reduction. PCP education on breast cancer prevention and establishing high-risk breast clinics may improve breast cancer chemoprevention uptake.