Background The accuracy of subjective risk perception is a matter of concern in breast cancer development. The objective of this study was to evaluate the accuracy of self-perceived risk assessment of breast cancer development and compared to actual risk in Iranian women. Methods The demographic, clinical, and reproductive characteristics of 800 women aged 35–85 years were collected with an in-person interview. The self-perceived risk and the actual risk were assessed using the visual analog scale (VAS) and he Gail model respectively. Gail’s cutoff of 1.66% risk was used to categorize the estimated 5-year actual risk as low/average risk ( 1.66%) and high risk (≥ 1.66). In low/average risk, if the self-perceived risk actual risk, then individuals were considered as overestimating. Similarly, in high-risk women, if the perceived risk actual risk, then, the subjects were labeled as under-estimate; otherwise, it was labeled as accurate. The Kappa statistics were used to determine the agreement between self-perceived risk and actual risk. ROC analysis was applied to determine the accuracy of self-perceived risk in the prediction of actual risk.