BACKGROUND: Brief pictograph measures of health functioning have clinical value to office-based practice. Many women with a close family history of breast cancer will experience worry about their risk of developing breast cancer that influences decision-making and can interfere with health-related functioning. PURPOSE: To develop a clinically - useful triage measure of breast cancer worry for the field setting of office based practice. METHODS: Design: qualitative pilot testing followed by mailed survey. Survey sample: women registered with the Cancer Genetics Network who have a first or second-degree family history of breast cancer and no personal history of any cancer. Novel measure: single pictograph item modeled upon the Dartmouth COOP Charts. Comparison gold-standard measure: four-item Cancer Worry Scale (CWS). RESULTS: Pilot testing: participants found the item to be easily understood, rapidly completed and unobtrusive. Quantitative: 469 women responded (78% response rate); the Cancer Worry Chart demonstrated strong correlation to the CWS (Pearson correlation coefficient: 0.66, P < 0.001); Receiver operator curve identified favorable characteristics (AUC = 0.86) of the Cancer Worry Chart for identifying cancer worry-related mood or social role dysfunction. CONCLUSIONS: The new Cancer Worry Chart is a valid triage measure for breast cancer worry. Copyright 2006 John Wiley & Sons, Ltd.