Background: Preventing breast cancer would be highly valued by all women. Recent attention about risk stratification for breast cancer in women stems from opportunities for risk reduction using chemopreventive agents like tamoxifen and raloxifen. Effectiveness of primary prevention for women at highest risk for breast cancer has resulted in strategies for implementing chemoprevention guidelines. The purpose of the current study was to characterize the current utilization of chemoprevention agents among hospitalized women who are at higher risk for breast cancer. Methods: A cross sectional bedside survey of 250 women aged 50-75 years hospitalized to a general medicine service was conducted. Reproductive history, family history for breast cancer, chemopreventive agents use, and medical comorbidities data was collected for all patients. Chi square and t-tests were utilized to analyze population characteristics. Results: Mean age for the study population was 61.5 years (SD 7.5), and mean 5-year Gail risk score was 1.67 (SD 0.88). A third of study population was at high risk for breast cancer (5-year Gail risk score ≥ 1.7). None of the high-risk women (0%) were taking chemoprevention for breast cancer risk reduction, and 7% were at very high risk with 5-year Gail score ≥ 3%. These women were not recognized as being high risk by their hospital providers and none were referred to the high risk breast cancer clinics following discharge. Conclusions: Many hospitalized women are at high risk for breast cancer and we could not identify even a single woman who was using chemoprevention for risk reduction. Current chemoprevention guidelines may be falling short in their dissemination and implementation. Because women at high risk for breast cancer may only interface with the healthcare system at select points, all healthcare providers must be willing and able to do risk assessment. For those identified to be at high risk, providers must then either engage in chemopreventive counseling or refer patients to providers who are more comfortable working with patients on this critical decision.