Background: Hereditary predisposition accounts for 5-10% of all breast cancers. NCCN guidelines recommend risk-management behaviors for women with lifetime breast cancer (BC) risk ≥20%. Prior research has mainly explored use of these options among white women with pathogenic BRCA variants or already in specialized high-risk care. Using a more inclusive sample, we aimed to assess awareness, utilization, and guideline-adherence related to BC risk-management options among a racially diverse, community-based sample. Methods: This study uses data (collected Oct 2018–Aug 2019) from a survey that included measures of risk-management behavior, potential correlates, and information necessary to determine lifetime BC risk. Eligible participants were Black and non-Hispanic white women aged 18-75 with no personal cancer history and lifetime BC risk ≥ 20%. Descriptive analyses assessed awareness and utilization of mammograms, breast MRIs, prophylactic oophorectomy, prophylactic mastectomy, and chemoprevention, and adherence to NCCN guidelines for use of these options. Logistic regression analyses ascertained the impact of BRCA mutation status, race, and health insurance on awareness, utilization, and adherence. Results: A total of 717 high-risk participants (35% Black) completed the survey; of these, 146 had pathogenic BRCA mutations. Most women were aware of breast MRI (79%) and mastectomy (84%) options; only 61% had heard of oophorectomy and 39% of chemoprevention. Utilization of risk-management practices was low: only 36% had a mammogram and 28% a breast MRI in the last 12 months. Of this sample, 10% had used risk-reducing mastectomy, 13% oophorectomy, and 2% chemoprevention. Only 32% of participants were fully adherent to NCCN screening guidelines for their risk level. Only 13% were fully adherent to risk-reduction guidelines for their risk level. White women, women with health insurance, and those with pathogenic BRCA mutations had higher odds of awareness, utilization, and guideline-adherence to most risk-management behaviors compared to their peers. Conclusions: Awareness, utilization, and guideline-adherence related to BC risk management were low among a racially diverse, community-based sample of high-risk women. Studies of barriers and facilitators are needed, as is development of patient- and system-level interventions to decrease disparities and increase use of risk-management behavior.