Comparison of false positive rates for screening breast MRI in high risk women when studies are done stacked versus alternating.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1512-1512
Author(s):  
Edress Othman ◽  
Jue Wang ◽  
Brian Sprague ◽  
Yongli Ji ◽  
Sally D. Herschorn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
False Positive ◽  
Brca Mutation ◽  
False Positive Rate ◽  
Menopausal Status ◽  
Breast Mri ◽  
High Risk Women ◽  
Increased Risk ◽  
Optimal Screening

1512 Background: Screening breast MRI added to mammography increases screening sensitivity for high risk women. However, false positive rates are high for MRI and the optimal screening schedule is unclear. In this study we compare rates of false positive MRI when studies were performed on a stacked or alternating schedule. Methods: We reviewed charts for women at increased risk for breast cancer who had screening breast MRI between 2004 - 2012 at the University of Vermont. Eligible women had at least 1 MRI and 1 mammogram performed within one year. Charts were abstracted for clinical, radiological, and biopsy data. Screening was considered stacked if both studies were performed within 90 days and alternating if studies were 4-8 months apart. False positive was defined as MRI result of BI-RADS 3-4-5-0 with additional negative imaging within 12 months or benign biopsy. Results: 143 women had screening which met inclusion criteria; 45 per stacked schedule, 52 alternating, 40 mixed and 6 neither. Women in this study had similar characteristics with respect to age, ethnicity, menopausal status and indications for MRI (i.e. family history, BRCA mutation, biopsy history and prior chest irradiation). 371 MRIs were reviewed (165 stacked and 206 alternating). The overall false positive rate was higher in the stacked group vs. alternating [30(18.2%) vs. 21(10.2%), p=0.0264]. Using only BI-RADS 4-5-0 as a positive result that difference was lost. There were significantly more BI-RADS category 3 interpretations in the stacked vs. alternating MRIs [16(9.7%) vs. 6(2.9%), p=0.006]. The rate of BI-RADS category 4-5-0 was not different between the two groups [16(9.7%) vs. 17(8.3%), p= 0.6272]. A similar number of biopsies were performed in both groups Conclusions: MRI added to mammography for women at increased risk for breast cancer was associated with higher rates of false positive interpretations when studies were done on a stacked compared to alternating schedule. In this study the greater number of BI-RADS 3 interpretations with a stacked schedule accounted for this difference. Further studies are needed to identify the optimal screening schedule when adding MRI to mammography.

Health-related quality of life among high-risk women in an MRI surveillance study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1522-1522
Author(s):  
A. R. Bradbury ◽  
S. A. Cummings ◽  
J. J. Dignam ◽  
L. Patrick-Miller ◽  
M. Verp ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
High Risk ◽  
Brca Mutation ◽  
Breast Mri ◽  
High Risk Women ◽  
History Of ◽  
History Of Cancer ◽  
Over Time

1522 Background: The quality of life (QOL) and psychological impact of incorporating MRI into breast cancer screening programs for high-risk women (HRW) has not been well studied. Psychological and biological risk factors, e.g. cancer history, BRCA mutation, imaging recall, generalized anxiety or clinical depression may mediate QOL outcomes. Methods: 100 HRW undergoing intensive surveillance including yearly mammography, semiannual breast ultrasound and breast MRI have completed QOL (SF-36), anxiety (STAI) and depression (Beck) questionnaires at semi-annual visits. 56 HRW have completed 3 screenings. Differences in QOL measures over time were evaluated using longitudinal regression models. Differences between participants and population norms (PN), women with/without a history of cancer and with/without a BRCA mutation were assessed using t-tests. Results: QOL scores increased over time and were statistically significant for the general health (GH) subscale (p=0.016). All QOL subscales were higher than PN at baseline and were significantly higher than PN at 12 months. Mean GH score at 12 months = 80.0, PN 72.7 (SD14.2, p<0.01). Mean mental health score at 12 months = 78.9, PN 73.4 (SD14.9, p<0.01). At baseline, BRCA carriers had lower QOL scores than non-carriers and women with a history of cancer had higher QOL scores than unaffected participants, although these differences were not statistically significant. Conclusions: These data suggest that intensive breast cancer screening incorporating breast MRI may have a positive effect among HRW. Continued enrollment will allow for multi-variate characterization of psychological and biological predictors of change in QOL and psychological well-being among high-risk women undergoing intensive screening. No significant financial relationships to disclose.

scholarly journals Current and Future Directions of Breast MRI

2021 ◽  
Vol 10 (23) ◽  
pp. 5668
Author(s):  
Margaret Houser ◽  
David Barreto ◽  
Anita Mehta ◽  
Rachel F. Brem
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Digital Breast Tomosynthesis ◽  
Breast Mri ◽  
Preoperative Assessment ◽  
Average Risk ◽  
Dense Breast Tissue ◽  
Increased Risk ◽  
High Risk Populations ◽  
Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI) is the most sensitive exam for detecting breast cancer. The American College of Radiology recommends women with 20% or greater lifetime risk of developing breast cancer be screened annually with MRI. However, other high-risk populations would also benefit. Hartmann et al. reported women with atypical hyperplasia have nearly a 30% incidence of breast cancer at 25-year follow-up. Women with dense breast tissue have up to a 4-fold increased risk of breast cancer when compared to average-risk women; their cancers are more likely to be mammographically occult. Because multiple cohorts of women are at high risk for developing breast cancer, there has been a movement to develop an abbreviated MRI (abMRI) protocol to expand the availability of MRI screening. Studies on abMRI effectiveness have been promising, with Weinstein et al. demonstrating a cancer detection rate of 27.4/1000 in women with dense breasts after a negative digital breast tomosynthesis. Breast MRI is also used to evaluate the extent of disease as part of preoperative assessment in women with newly diagnosed breast cancer, and to assess a patient’s response to neoadjuvant chemotherapy. This paper aims to explore the current uses of MRI and propose future indications and directions.

A PRELIMINARY STUDY OF RISK FACTORS OF BREAST CANCER AND THE USEFULNESS OF BREAST MRI AS AN ADDITION TO MAMMOGRAPHY IN DETECTING BREAST CANCER IN HIGH RISK WOMEN

2016 ◽  
Vol 78 (11-3) ◽  
Author(s):  
Noor Khairiah A. Karim ◽  
Rohayu Hami ◽  
Nur Hashamimi Hashim ◽  
Nizuwan Azman ◽  
Ibrahim Lutfi Shuaib
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Cancer Detection ◽  
Significant Risk ◽  
Breast Mri ◽  
Breast Cancer Detection ◽  
P Value ◽  
High Risk Women ◽  
History Of

The risk factors of breast cancer among women, such as genetic, family history and lifestyle factors, can be divided into high-, intermediate- and average-risk. Determining these risk factors may actually help in preventing breast cancer occurrence. Besides that, screening of breast cancer which include mammography, can be done in promoting early breast cancer detection. Breast magnetic resonance imaging (MRI) has been recommended as a supplemental screening tool in high risk women. The aim of this study was to identify the significant risk factor of breast cancer among women and also to determine the usefulness of breast MRI as an addition to mammography in detection of breast cancer in high risk women. This retrospective cohort study design was conducted using patients’ data taken from those who underwent mammography for screening or diagnostic purposes in Advanced Medical and Dental Institute, Universiti Sains Malaysia, from 2007 until 2015. Data from 289 subjects were successfully retrieved and analysed based on their risk factors of breast cancer. Meanwhile, data from 120 subjects who had high risks and underwent both mammography and breast MRI were further analysed. There were two significant risk factors of breast cancer seen among the study population: family history of breast cancer (p-value=0.012) and previous history of breast or ovarian cancer (p-value <0.001). Breast MRI demonstrated high sensitivity (90%) while mammography demonstrated high specificity (80%) in detection of breast cancer in all 120 subjects. The number of cases of breast cancer detection using breast MRI [46 (38.3%)] was higher compared to mammography [24 (20.0%)]. However, breast MRI was found to be non-significant as an adjunct tool to mammography in detecting breast cancer in high risk women (p-value=0.189). A comprehensive screening guideline and surveillance of women at high risk is indeed useful and should be implemented to increase cancer detection rate at early stage

Breast Cancer in Young Women after Treatment with Irradiation for Hodgkin’s Lymphoma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3333-3333
Author(s):  
Linda Lee ◽  
Melania Pintilie ◽  
David Hodgson ◽  
Michael Crump
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Breast Density ◽  
Young Women ◽  
Cumulative Incidence ◽  
Breast Mri ◽  
Increased Risk

Abstract BACKGROUND: Women who are survivors of Hodgkin’s Lymphoma (HL) are at increased risk of developing breast cancer (BCa) as a long-term complication due to the use of extended field (mantle) irradiation (RT) of disease above the diaphragm. Many young women are at significantly increased risk of BCa prior to the age at which routine screening mammography is recommended for the general population. The sensitivity of mammography is lower in these women, in part due to increased breast tissue density characteristic of young pre-menopausal women. Currently, there is a paucity of information on the optimal screening modality and surveillance frequency for these women. METHODS: We reviewed the current BCa screening strategies used for this high risk group at our centre and described the incidence, method of detection, and characteristics of secondary BCas in a cohort of 115 women who received supradiaphragmatic RT for HL before age 30 between 1965 and 2000 at Princess Margaret Hospital (PMH) and who subsequently accepted long-term follow-up in a high-risk screening clinic. RESULTS: Median age at treatment was 22 (range 9–30). Radiation fields were mantle in 106 women, modified mantle in 6, and involved field in 3 (median dose delivered: 35 Gy, range 15–60). RT alone was used for 44 patients while 71 received combined modality therapy, of which 45 (65%) received MOPP. Treatment induced amenorrhea occurred in 15 women (median age 38); hormone replacement therapy was subsequently used by 9. Of the 107 women who participated in annual radiographic BCa screening, 95 were screened with mammogram alone, 1 with breast MRI alone, 8 with mammogram and MRI, and 3 with mammogram and ultrasound. Median age at first mammogram was 36; however, median age decreased with more recent year of HL diagnosis (age 40 for women diagnosed before 1985 compared to age 33 for women diagnosed after 1985, p<0.0001). Women with high breast density received MRI screening more often (p=0.02); however, breast density was not significantly associated with previous breast radiation dose or age at last follow-up. Twelve women were diagnosed with BCa in this cohort, following active breast surveillance for a median of 5 years (representing 584 person-years). The 20-year cumulative incidence of breast cancer was 10.9% (95% CI 5.3–18.8%) in this group of women. This was comparable to the 20-year cumulative incidence of breast cancer of 12% (95% CI 8–17%) in all 448 women with HL treated with supradiaphragmatic radiation before age 30 at PMH during the same time period. BCa occurred after a median of 17 years after treatment for HL (range 13–28). Median age at BCa diagnosis was 40 (range 31–51). Seven cancers were detected by physical exam (6 node-positive invasive BCas, 1 in-situ BCa) and 5 were detected on annual mammograms (1 node-positive invasive BCa, 4 in-situ BCas). CONCLUSIONS: Although women in the more recent treatment cohort are receiving their first mammogram at a younger age, the majority of BCas were still detected clinically, and these BCas had less favorable pathological characteristics. More frequent breast imaging should be considered in women who have had supradiaphragmatic RT for HL. Prospective evaluation of breast MRI as a screening strategy for HL survivors has been initiated at PMH in an effort to detect BCa at an earlier stage.

Clinical factors affecting HE4 and CA125 in women at high risk of developing ovarian cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1569-1569
Author(s):  
Archana Raamanathan ◽  
Laura L. Holman ◽  
Diana L Urbauer ◽  
Keith A. Baggerly ◽  
Yu Shen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
High Risk ◽  
Menstrual Cycle ◽  
Smoking Status ◽  
Brca Mutation ◽  
Menopausal Status ◽  
Clinical Factors ◽  
Multilevel Regression ◽  
Hormone Use

1569 Background: CA125 is often used to screen high-risk patients (pts) for ovarian cancer (OC), but levels are affected by many factors, especially in premenopausal pts. In prior studies of low-risk pts, HE4 is more stable than CA125. The objective of this study was to determine how clinical variables affect CA125 and HE4 in pts at high risk for ovarian cancer. Methods: Serum from 373 pts at high risk of OC was collected every 3-12 mo from 2006-2012, for a total of 1081 samples. Serum CA125 and HE4 were measured in duplicate utilizing a commercially available multiplexed sandwich immunoassay (MagPlex). Multilevel regression models were used to examine the associations of clinical factors with CA125 and HE4, while considering the inter-correlated nature of outcomes measured periodically from the same subject. Results: The mean age was 44.6 years, 51.2% were premenopausal, 72.7% were white, 9.1% were Ashkenazi Jewish, 65.2% had a history of breast cancer, and 81.5% had a BRCA mutation. Log transformed CA125 was found to be 0.32 units higher in premenopausal pts compared to postmenopausal pts (p=0.0023), and 0.27 units higher in pts with active breast cancer (BC) compared to pts with no active BC (p=0.0044). In premenopausal pts, CA125 varied throughout the menstrual cycle, with highest levels noted at menstruation (p<0.0001). Age, smoking status, and hormone use did not affect CA125 levels. Interestingly, there was no significant association between HE4 levels and any of the evaluated variables, including age, menopausal status, active BC, smoking status, hormone use, or point in menstrual cycle (all p>0.05). Conclusions: In women at high-risk for OC, HE4 levels fluctuate less with the menstrual cycle and are less likely to be elevated in BC than CA125. This finding is important as many high-risk pts that undergo screening are pre-menopausal and have a BC history. HE4 may provide a valuable addition to the current screening regimen of high-risk pts.

scholarly journals A prospective clinical trial to compare the performance of dried blood spots prenatal screening for Down’s syndrome with conventional non-invasive testing technology

2017 ◽  
Vol 242 (5) ◽  
pp. 547-553
Author(s):  
Huiying Hu ◽  
Yulin Jiang ◽  
Minghui Zhang ◽  
Shanying Liu ◽  
Na Hao ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
False Positive Rate ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Dried Blood Spots ◽  
High Risk Women ◽  
Secondary Screening ◽  
Serum Screening ◽  
Positive Rate

To evaluate, side by side, the efficiency of dried blood spots (DBSs) against serum screening for Down’s syndrome, and then, to construct a two-tier strategy by topping up the fetal cell-free DNA (cfDNA) secondary screening over the high-risk women marked by the primary blood testing to build a practical screening tactic to identify fetal Down’s syndrome. One thousand eight hundred and thirty-seven low-risk Chinese women, with singleton pregnancy, were enrolled for the study. Alpha-fetoprotein and free beta human chorionic gonadotropin were measured for the serum as well as for the parallel DBS samples. Partial high-risk pregnant women identified by primary blood testing (n = 38) were also subject to the secondary cfDNA screening. Diagnostic amniocentesis was utilized to confirm the screening results. The true positive rate for Down’s syndrome detection was 100% for both blood screening methods; however, the false-positive rate was 3.0% for DBS and 4.0% for serum screening, respectively. DBS correlated well with serum screening on Down’s syndrome detection. Three out of 38 primary high-risk women displayed chromosomal abnormalities by cfDNA analysis, which were confirmed by amniocentesis. Either the true detection rate or the false-positive rate for Down’s syndrome between DBS and the serum test is comparable. In addition, blood primary screening aligned with secondary cfDNA analysis, a “before and after” two-tier screening strategy, can massively decrease the false-positive rate, which, then, dramatically reduces the demand for invasive diagnostic operation. Impact statement Children born with Down’s syndrome display a wide range of mental and physical disability. Currently, there is no effective treatment to ease the burden and anxiety of the Down’s syndrome family and the surrounding society. This study is to evaluate the efficiency of dried blood spots against serum screening for Down’s syndrome and to construct a two-tier strategy by topping up the fetal cell-free DNA (cfDNA) secondary screening over the high-risk women marked by the primary blood testing to build a practical screening tactic to identify fetal Down’s syndrome. Results demonstrate that fetal cfDNA can significantly reduce false-positive rate close to none while distinguishing all true positives. Thus, we recommend that fetal cfDNA analysis to be utilized as a secondary screening tool atop of the primary blood protein screening to further minimize the capacity of undesirable invasive diagnostic operations.

Investigation of Endometrial Abnormalities in Asymptomatic Women Treated With Tamoxifen and an Evaluation of the Role of Endometrial Screening

1999 ◽  
Vol 17 (7) ◽  
pp. 2050-2050 ◽  
Author(s):  
C.D.B. Love ◽  
B. B. Muir ◽  
J. B. Scrimgeour ◽  
R. C.F. Leonard ◽  
P. Dillon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
False Positive ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
False Positive Rate ◽  
Low Frequency ◽  
Endometrial Thickening ◽  
Increased Risk ◽  
Outpatient Hysteroscopy ◽  
Asymptomatic Women

PURPOSE: Tamoxifen is the most commonly prescribed adjuvant therapy for women with breast cancer. It has agonist activity on the endometrium and is associated with an increased risk of endometrial cancer. The aim of this study was to evaluate whether screening with transvaginal ultrasound (TV USS) with or without hysteroscopy is worthwhile. PATIENTS AND METHODS: A total of 487 women with breast cancer, 357 treated with tamoxifen and 130 controls, were screened with TV USS, and endometrial thickness was measured. Women with thickened endometrium underwent outpatient hysteroscopy. RESULTS: Length of time on tamoxifen ranged from 5 to 191 months (mean, 66 months), and endometrial thickness ranged from 1 to 38 mm (mean, 7.3 mm). Women treated with tamoxifen had significantly thicker endometrium than did controls (P < .0001). There was a statistically significant (P < .0001) positive correlation between length of time on tamoxifen and endometrial thickness. One hundred forty-five women had endometrium greater than 5 mm on USS, and 134 underwent successful outpatient hysteroscopy, 61 of whom had atrophic endometrium, resulting in a 46% false-positive scan rate. The remaining women all had benign features to explain the USS findings. CONCLUSION: TV USS detects a high incidence (41%) of apparent endometrial thickening in women treated with tamoxifen, although 46% had atrophic endometrium on further assessment, and none of the remaining asymptomatic women had significant lesions. Length of time on tamoxifen relates to endometrial thickening as measured by TV USS. TV USS is a poor screening tool because of the high false-positive rate. The low frequency of significant findings suggests that endometrial screening in asymptomatic women is not worthwhile.

Efficacy of breast MRI in elderly women

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 608-608
Author(s):  
J. Yu ◽  
E. Morris ◽  
A. Park ◽  
H. Cody ◽  
M. L. Gemignani
Keyword(s):  
Breast Cancer ◽  
False Positive ◽  
Elderly Women ◽  
False Positive Rate ◽  
Breast Mri ◽  
Disease Assessment ◽  
Mri Findings ◽  
History Of ◽  
Diagnosis Of Cancer ◽  
Extent Of Disease

608 Background: Breast MRI is useful in evaluating extent of disease and screening of high risk patients, especially younger patients with dense breasts. The utility of MRI in the elderly population is currently unknown. The purpose of this study was to review the use of breast MRI and MRI findings in elderly women. Methods: Retrospective review identified women over the age of 70 who underwent breast MRI at our institution between 11/2000 and 12/2005. Clinicopathologic features, MRI results and mammograms (MMG) were reviewed. Results: 228 patients were identified. The mean age was 73.5 years (range 70–91). Forty-three patients (19%) had no history of breast cancer, 99 (43%) had a history of breast cancer, and 86 (38%) had a current diagnosis of breast cancer at the time of MRI. Ninety-two patients (40%) underwent MRI for screening, 49 (21%) as further workup for an abnormal MMG or physical finding, and 78 (34%) for extent of disease assessment. MRI found 49 additional sites of abnormality and 15 additional cancers (14% false positive). Five cancers were detected in women with no current diagnosis of cancer. In patients with a diagnosis of cancer at the time of MRI, 10 additional cancers were found: 7 in the contralateral breast and 3 additional ipsilateral sites. Conclusions: MRI detected an additional 15 mammographically occult breast cancers in this population of women over the age of 70. MRI was efficacious in screening as well as evaluating extent of disease, with a relatively low false-positive rate of 14%. Breast MRI is a useful tool in the evaluation of elderly patients; further study in the use of MRI for screening in this population is needed. [Table: see text] No significant financial relationships to disclose.

Group visits for women at high risk for breast cancer: Facilitated education and support sessions.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 30-30 ◽  
Author(s):  
Kathryn Trotter ◽  
Victoria Seewaldt ◽  
Stephanie Riley
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Brca Mutation ◽  
Screening Tests ◽  
Mental Health Provider ◽  
Breast Clinic ◽  
Conference Room ◽  
Group Visit ◽  
Increased Risk ◽  
High Risk Breast

30 Background: Women at increased risk for breast cancer frequently have anxiety and stress. They often have questions and concerns that are not discussed at their medical appointment. Methods: The Duke High-Risk Breast Clinic consists of over 1,110 women undergoing high-risk screening due to 1) BRCA-mutation, 2) familial pattern of breast cancer inheritance, 3) prior abnormal biopsy, or 4) > 20% lifetime risk of breast cancer. Approximately 31% of clinic participants are African-American and 65% are European-American. Women participating in the Duke High-Risk Breast Clinic were offered a monthly, hour-long education and support session at no charge. The goal was to help women answer key questions and provide a supportive environment. A five-month pilot was initiated in 02/2015. The NP adapted the Centering Healthcare Institute’s group visit model (www.centeringhealthcare.org). Attendees completed a Self-Assessment Sheet (SAS) on arrival. A clinic conference room was used, with chairs arranged in a circle, and refreshments available. After an icebreaker opening, the NP led a facilitated discussion on timely topics, which the patients actively prioritized. Guest experts (radiologist, geneticist, gynecologist, mental health provider) also participated. A participant or the team navigator led the closing activity, and then a brief patient satisfaction survey was completed. Patient support persons were welcomed. Results: 100% of the participants (N = 38) strongly agreed that the educational session was a resourceful way of addressing healthcare concerns, and 92% agreed that they would attend more educational sessions. Several women came at least 3 of the sessions with 30% traveling 1-3 hours. Comments were positive. Common topics on the SAS were: genetic risk/testing, risk factors for breast cancer, screening tests/tools, and nutrition. Further topics requested: “When to be concerned about aches, pains, ‘lumps’, and how not to over react”, research updates, 3D imaging, and stress. Conclusions: Women found this group visit model highly informative and helpful. Several commented they would like the sessions to be longer, or be offered in the evening. Further commitment to this group visit format is warranted.

Breast cancer screening practices with high-risk women: A cross-sectional survey.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1550-1550
Author(s):  
Anne Hudson Blaes ◽  
Rachel Isaksson Vogel ◽  
Nancy Raymond ◽  
Kristine Talley ◽  
Alicia Allen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
High Risk ◽  
Breast Cancer Screening ◽  
Breast Mri ◽  
Primary Care Providers ◽  
Care Providers ◽  
Screening Practices ◽  
High Risk Women

1550 Background: Little literature exists on primary care providers’ knowledge and preferences towards breast cancer screening for high-risk women. While guidelines recommend MRI and mammography, it is unclear how frequently these recommendations are used. Methods: This web-based survey of providers licensed to practice in Minnesota was conducted. This analysis focuses on breast cancer screening practices for high-risk women. Data were summarized using descriptive statistics; professional characteristic comparisons were conducted using Chi-squared tests. Results: 805 of 10,392 (8%) invitees completed the survey. 72.2% were female. 43.9% were physicians (20.8% internists, 71.7% family medicine, 6.3% gynecology), 11.4% physician assistants (PAs), 44.8% advanced practice registered nurses (APRNs). 84.8% were in community practice, 38% > 20 years of experience and 27.1% < 10 years. When asked how effective screening was for reducing cancer mortality in high risk women, mammography was thought to be very effective (48.8%) or effective (46.8%) in women ages 40-49 years, for women ages 50+ years, 60.8% and 35.7%, respectively. 62.4% thought breast MRI was very effective in reducing cancer mortality in high risk women. There was no difference in breast MRI recommendation based on professional background, experience or practice setting. Female practitioners, less experience, and those working in gynecology or women’s health were more likely to recommend breast MRI. A case vignette for high risk screening cancer survivors is provided (Table). Conclusions: Most primary care providers believe mammography is helpful in women at high risk for developing breast cancer. Less than half of practitioners, however, are following guideline specific recommendations of both mammography and MRI for breast cancer screening in high-risk patients. [Table: see text]

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