Breast cancer is the most common malignancy in women worldwide and the leading cause of death from malignancies. In addition to better therapies, it is possible to reduce breast cancer mortality using more effective primary and secondary prevention. One possibility to improve prevention is the modification of screening programmes as women’s risks for developing breast cancer are different. Implementation of personalised risk predictions is possible by using monogenic genetic testing and polygenic risk scores combined with lifestyle and hormonal risk factors. Personalised risk estimation could serve as the basis for the shared decision on implementation of breast cancer primary and secondary prevention.