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Abstract: This multicentre study investigated accuracy of perceived breast cancer risk and breast cancer genetics knowledge in 333 women at increased risk of developing hereditary breast cancer. Only women who had never been affected by breast cancer and approached one of 14 familial cancer clinics for advice about their breast cancer risk were assessed prior to their attendance at the clinic. Eleven percent of women underestimated. 57% accurately estimated their risk and 32% overestimated their breast cancer risk. Compared to accurate estimators, overestimators were younger (OR = 0.97: 95% CI, 0.95-1.00;P = .051), had higher breast cancer anxiety levels (OR = 1.03; 95% CI, 1.01-1.05; p = .0038) and were more likely to fall into the lower breast cancer risk categories (P < .0001). These findings suggest that an approach that exclusively relies on conveying factual information on breast cancer risk is unlikely to succeed in correcting excessive risk perceptions, and that it may be necessary to also address excessive breast cancer anxiety. Furthermore, many women at high risk of developing breast cancer have misconceptions about breast cancer genetics, underscoring the value of referral to comprehensive specialist counselling services.