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Objective:
In 2018, the American College of Radiology (ACR) changed MRI screening guidelines for patients with a personal history of breast cancer (PHBC). Previously, only women with PHBC and a known genetic mutation (KGM) were recommended for annual screening MRI, in addition to mammogram. Under new guidelines, PHBC patients with either dense breasts or diagnosis before age 50 are also recommended for supplemental MRI. This population expansion is expected to have a positive impact, as MRI is a more sensitive screening tool, which may improve detection of mammographically occult breast cancer. This project evaluates the extent to which these new guidelines impact eligibility for supplemental screening, in addition to what differentiating factors may impact utilization of MRI in this population.

Materials and Methods:
Data from 7/20/21 to 7/19/21 were extracted from the EMR. Patients included were aged 25-75 with PHBC and dense breasts, diagnosis <50, or KGM. The data were grouped based on demographics, risk qualification (breast density, diagnosis <50, or KGM), insurance type, high-risk provider, and screening location. MRI utilization for all cohorts was analyzed with Chi-square tests. Post-hoc analysis and pairwise comparisons included Mantel-Haenszel Chi-Square and Turkey-Kramer tests.

Results:
Data from 929 patients were analyzed, of which 664 (71.5%) had dense breasts and 541 (58.2%) were diagnosed <50. Only 65 (7%) had a KGM, representing those that qualified for MRI before 2018 guideline changes. 325 (35%) patients received the recommended supplemental MRI, while 604 (65%) did not. Significant differences in MRI uptake were seen with age, insurance type, risk qualification, and high-risk provider. Increasing age is associated with decreasing MRI uptake (p < .0001). Patients with high-risk providers had higher uptake of MRI (p = 0.004). Patients with commercial insurance had higher MRI uptake than those with Medicare/Managed Care (p = 0.0034). Breast density was the only risk category with significantly higher MRI Uptake (p < 0.0001). Patients with dense breasts alone had higher MRI uptake than those only with diagnosis < 50 (p = 0.0153). Patients with dense breasts and diagnosis <50 had higher uptake than those with only diagnosis <50 (p < 0.0001). Patients with dense breasts and KGM had higher MRI uptake than those with only diagnosis <50 (p = 0.0379). No significant differences in MRI uptake were seen with race or language.

Conclusion:
After the 2018 ACR guideline changes, our patient population eligible for supplemental screening with MRI has increased 14-fold. In the PHBC population, breast density had the largest impact on MRI uptake of any single risk qualification and patients with both dense breasts and KGM had the largest MRI uptake of any risk cohort. These findings may be attributable to increasing social awareness surrounding the challenges of cancer detection with breast density. These findings will guide future interventions to further increase MRI utilization and improve early detection and treatment success of new or recurrent cancer in this high-risk population.