Medicine is a less exact science than many believe; it is fraught with a myriad of uncertainties that can make decision making in women with breast cancer, or women who are at high genetic risk for it, very difficult. Even the best information available may be inadequate, with limited data about effectiveness or trade-offs between benefits and harms. The quality of any evidence concerning treatment risks is ultimately dependent on the veracity of good clinical trial data, followed by careful and comprehensive systematic monitoring of therapeutic endeavours in the clinic. All decisions women may make, from consenting to diagnostic tests, choice of surgery or systemic treatments, to consideration of lifestyle changes, are made on the basis of implicit or explicit judgements about the risk or perceived benefit/harm ratios. Patients must consider their own personal risk for either developing breast cancer and/or having a recurrence of their disease, and then balance these risks against the harms and benefits of various screening procedures or treatments. Inaccurate risk perceptions may lead to suboptimal decision making, so all health care professionals need to be aware of the impact that their own communication may have on patients' understanding and on some of the psychological issues that influence the lay populations' beliefs and behaviours.