<p>The breast cancer risk assessment service (BCRAS) at Guy’s Hospital, London, provides a community-based, nurse-led service to women or men with a personal or family history of breast or ovarian cancer. This article discusses the background to establishing the service and its day-to-day running in an area of cultural, ethnic and social diversity. The service covers three south London boroughs with a combined population of around one million. The service concentrates on offering access to screening, health education and reassurance to people in at-risk groups. BCRAS also triages patients for direct referrals to the hospital’s clinical genetics service for further investigation. The clinics that are run as part of the service are held in non-hospital settings and self-referrals are encouraged to maximise access.</p>