This study was designed to examine and explain the use of risk-reducing behaviors in a group of women recruited from the community who had a family history of breast cancer. An empirically derived model was developed that included variables hypothesized to influence adherence intentions, early detection behaviors, and high-risk clinic contact intentions. The model included the background variables of age, objective risk, education, income, and healthcare communication and the proximal variables of perceived risk, cancer specific distress, and attitude. This study also prospectively examined the use of high-risk services. Participants included women (N = 187) with a family history of breast cancer who had no prior contact with a high-risk or familial breast cancer clinic or program. Study hypotheses were tested with correlational analyses, structural equation modeling (SEM), and logistic regression. Results of SEM found that the proposed variables accounted for 42% of the variance in adherence intentions, and 23% of the variance in both early detection behaviors and clinic contact intentions. Approximately 24% of the women who participated in this study contacted the high-risk clinic to receive additional information about their risk. Predictors of clinic contact included higher objective risk, higher clinic contact intentions, lower perceived risk, and higher cancer distress. Implications of these findings are discussed.