There are two gaps in the present approach to breast cancer (BC) screening. First, access to mammography is often linked to socio-economic status, either of the individual or the country providing BC screening. Second, the BC incidence rate among women less than 40 years of age, commonly considered having high risk-benefit ratio for mammographic screening, is currently increasing the fastest of all age groups. Hence, both groups commonly access mammographic screening once they become symptomatic and thus are typically diagnosed with late-stage breast cancer, severely impacting long-term survival and often resulting in increased treatment costs. A safe and inexpensive pre-screening technology, which can identify women at risk of harboring early-stage BC or having very high mammographic breast density, and thus being at an elevated risk to develop BC in the future, can personalize a woman’s entry age into mammographic screening thus optimizing all women’s risk-benefit ratio related to their breast cancer screening. The Optical Breast Spectroscopy (OBS) device developed in our group is a portable device which quantifies the optical density of breast tissue employing up to 13 red/NIR wavelengths. Principal components analysis and tissue chromophore quantification allow identification of women with high mammographic density and hence elevated risk when combined with other risk factors such as BMI and menopausal status. Loss of left-right symmetry in the principal component scores or the tissue chromophores shows potential as an indicator of the presence of BC, although larger population studies are needed to validate the metrics. Longitudinal measurements improve the risk prediction.