Objectives: Guidelines for the ideal strategy to assess cancer risk are lacking, leaving providers with options, including the National Comprehensive Cancer Network (NCCN) guidelines and several validated risk assessment models. We sought to compare the utilization of the NCCN guidelines and validated risk assessment models in a gynecologic oncology outpatient clinic population. Methods: This is a subset analysis of a prospective randomized controlled trial of a web-based tool for collecting family cancer history with the following embedded cancer risk assessment models: breast and ovarian BRCAPRO, Claus, Tyrer-Cuzick, Gail, colorectal and endometrial MMRPRO, MELAPRO, PANCPRO, and PREMM. All patients were invited to complete 3-generation family history with the webbased risk assessment tool. Using the NCCN Guidelines for Hereditary Cancer Testing Criteria as a reference, a manual review of the family history data was performed. Patients meeting NCCN criteria based on family history and/or elevated genetic risk based on prior probability models were recommended for a comprehensive genetic cancer risk evaluation. Results: Among 88 patients who completed the web-based tool between September 2019 and September 2021, 37 patients (42.0%) were identified to be at increased risk for cancer. Thirty-one patients (35.2%) were identified as high-risk by manual application of NCCN guidelines, and 26 patients (29.5%) had elevated cancer risk or mutation probability on ≥1 risk assessment model. Eleven patients met NCCN guidelines but did not have an elevated risk assessment score, and six patients had an elevated risk assessment score but did not meet NCCN guidelines (Table 1). In total, 17 patients (19.3%) who completed validated risk assessment and manual application of NCCN guidelines based on family history were identified as high-risk by one but not both methods of risk assessment. Conclusions: In our cohort of gynecologic oncology patients, 37 (42.0%) had an elevated risk for cancer. Among this group, 20 patients (54.0%) were identified by both NCCN criteria and validated risk assessment models; however, six patients (16.2%) would have been missed with the utilization of the NCCN criteria alone and 11 (29.7%) with validated risk assessment models alone. Limitations of cancer risk assessment models include patient ineligibility based on age and specific cancer histories, while NCCN guidelines do not incorporate environmental factors into risk assessment. Performance of cancer risk assessment in outpatient clinics is limited by the requirements on provider time and frequently evolving and complex guidelines. Future studies should aim to identify comprehensive, patient- and physician-centered strategies that maximize identification of those patients who warrant heightened cancer screening and genetic testing. Objectives: Guidelines for the ideal strategy to assess cancer risk are lacking, leaving providers with options, including the National Comprehensive Cancer Network (NCCN) guidelines and several validated risk assessment models. We sought to compare the utilization of the NCCN guidelines and validated risk assessment models in a gynecologic oncology outpatient clinic population. Methods: This is a subset analysis of a prospective randomized controlled trial of a web-based tool for collecting family cancer history with the following embedded cancer risk assessment models: breast and ovarian BRCAPRO, Claus, Tyrer-Cuzick, Gail, colorectal and endometrial MMRPRO, MELAPRO, PANCPRO, and PREMM. All patients were invited to complete 3-generation family history with the webbased risk assessment tool. Using the NCCN Guidelines for Hereditary Cancer Testing Criteria as a reference, a manual review of the family history data was performed. Patients meeting NCCN criteria based on family history and/or elevated genetic risk based on prior probability models were recommended for a comprehensive genetic cancer risk evaluation. Results: Among 88 patients who completed the web-based tool between September 2019 and September 2021, 37 patients (42.0%) were identified to be at increased risk for cancer. Thirty-one patients (35.2%) were identified as high-risk by manual application of NCCN guidelines, and 26 patients (29.5%) had elevated cancer risk or mutation probability on ≥1 risk assessment model. Eleven patients met NCCN guidelines but did not have an elevated risk assessment score, and six patients had an elevated risk assessment score but did not meet NCCN guidelines (Table 1). In total, 17 patients (19.3%) who completed validated risk assessment and manual application of NCCN guidelines based on family history were identified as high-risk by one but not both methods of risk assessment. Conclusions: In our cohort of gynecologic oncology patients, 37 (42.0%) had an elevated risk for cancer. Among this group, 20 patients (54.0%) were identified by both NCCN criteria and validated risk assessment models; however, six patients (16.2%) would have been missed with the utilization of the NCCN criteria alone and 11 (29.7%) with validated risk assessment models alone. Limitations of cancer risk assessment models include patient ineligibility based on age and specific cancer histories, while NCCN guidelines do not incorporate environmental factors into risk assessment. Performance of cancer risk assessment in outpatient clinics is limited by the requirements on provider time and frequently evolving and complex guidelines. Future studies should aim to identify comprehensive, patient- and physician-centered strategies that maximize identification of those patients who warrant heightened cancer screening and genetic testing.