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However, primary care providers report both discomfort with and a lack of medical knowledge on this topic. In this review we present a practical, evidence-based guide for incorporating breast cancer risk assessment and chemoprevention into routine care. We advocate a stepwise approach consisting of: (1) risk assessment and communication, (2) selection of appropriate chemoprevention based on risk\u2013benefit analysis, (3) shared decision-making regarding chemoprevention, and (4) management of chemoprevention side effects. We encourage providers to identify high-risk women and refer them to genetic counseling or a high-risk breast cancer clinic. For women who are not considered high risk, we suggest using the Gail model to estimate a woman's 5-year risk of invasive breast cancer. Usually, the benefits of chemoprevention outweigh the risks of chemoprevention once a woman's 5-year risk of invasive breast cancer reaches 3%. For these women there are several factors that need to be considered when selecting a chemoprevention agent, including patient preference, thrombotic history, menopausal status, absence or presence of a uterus, and bone mineral density. We advocate an evidence-based shared decision-making approach that reflects the woman's individual preferences when communicating risk and counseling about chemoprevention. After starting a chemoprevention agent, close follow-up is important as side effects of chemoprevention are common, including vasomotor symptoms and arthralgias. We also review evidence-based management of chemoprevention side effects.<\/jats:p>","DOI":"10.1089\/jwh.2018.7643","type":"journal-article","created":{"date-parts":[[2019,9,27]],"date-time":"2019-09-27T14:23:05Z","timestamp":1569594185000},"page":"46-56","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Breast Cancer Chemoprevention: A Practical Guide for the Primary Care Provider"],"prefix":"10.1177","volume":"29","author":[{"given":"Amy","family":"Farkas","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin."},{"name":"Department of Medicine, Clement Zablocki Milwaukee VA Medical Center, Milwaukee, Wisconsin."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Vanderberg","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Merriam","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."},{"name":"Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"DiNardo","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."},{"name":"Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,1,13]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"American Cancer Society. 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