BACKGROUND: Women at risk for inherited breast cancer have been identified for intervention studies through newly diagnosed relatives or from volunteers with a family history. This pilot study tested the use of a mammography registry to identify women at risk. METHOD: Fifty women with first-degree relatives diagnosed as having breast cancer before age 45 were randomly selected from the Vermont Breast Cancer Surveillance System. Thirty-three women (66%) completed a phone interview that included a three-generation family pedigree of breast and ovarian cancers. RESULTS: Fifty-one percent of the women were at higher risk for inherited breast cancer based on the family history. Eighteen percent of the first-degree relatives' breast cancers were pathologically confirmed. CONCLUSION: Mammography registries that collect similar family history data may be used to identify women at risk for inherited breast cancer. Many intervention studies would require improved methods to obtain pathologic confirmation.