Modifiedsierra health and lifePolicy 2026T0375LL

Breast Imaging for Screening and Diagnosing Cancer

Defines coverage and medical necessity criteria for breast imaging modalities (especially breast MRI) for screening and diagnosis of breast cancer for UnitedHealthcare Commercial and Individual Exchange plans.

Policy Summary

Payersierra health and life

PolicyBreast Imaging for Screening and Diagnosing Cancer

Policy CodePolicy 2026T0375LL

Change TypeRevised coverage criteriaadded definitionsclarified screening age rules

Effective DateFeb 1, 2026

Next Review Date

Key ActionObtain and document risk assessment, breast density, and supporting evidence when requesting prior authorization for screening breast MRI.

SourceLink

POLICY UPDATE CHANGES

Revised coverage criteria for magnetic resonance imaging of the breast for individuals who are high risk for breast cancer, including adding a requirement for heterogeneously or extremely dense breasts (Category C or D) with screening beginning at age 40.

Added definition of 'Breast Composition Categories'.

Replaced 'MRI of the breast for individuals with dense breast tissue not accompanied by defined risk factors' with 'MRI of the breast for individuals who do not meet the criteria [listed in the policy]'.

Screening can begin at the listed age or starting 10 years prior to the age of diagnosis of the earliest relative (up to third-degree relatives), whichever comes first, but not before age 25.

>=20%Lifetime risk threshold

Age 40Screening start age (density)

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SeveralModalities NMN

MultipleProcedure codes listed

Coverage and Medical Necessity Criteria

Medically necessary indications for breast MRI (screening)

MRI of the breast is proven and medically necessary for individuals at high risk when any ONE of the following applies:

High-risk MRI indications: Heterogeneously dense breasts (Category C) or extremely dense breasts (Category D) — screening beginning at age 40.

High-risk MRI indications: Prior thoracic radiation therapy between ages 10 and 30 — screening starting at age 25 or 8 years after treatment, whichever is later.

High-risk MRI indications: Estimated lifetime risk ≥ 20% using validated models largely dependent on family history (e.g., Gail, Claus, Tyrer-Cuzick, BRCAPRO) — screening beginning at age 40.>= 20%

High-risk MRI indications: Personal history of breast cancer (unless treated with bilateral mastectomy).

High-risk MRI indications: Pathogenic or likely pathogenic germline mutation carriers with specified start ages: BRCA1/BRCA2 (start at age 25); ATM, CDH1, CHEK2, NF1, PALB2, PTEN, STK11, BARD1, RAD51C, RAD51D (start ages as listed in policy, commonly age 30–40 depending on gene); TP53 mutation (start at age 20).

High-risk MRI indications: Family history patterns meeting defined criteria (examples: at least one first-degree relative with BRCA1/BRCA2 mutation; first-degree relative with TP53 or PTEN mutation; at least two first-degree relatives with breast or ovarian cancer; one first-degree relative with bilateral breast cancer or both breast and ovarian cancer; first- or second-degree male relative with breast cancer) — screening beginning at age 40 unless earlier age per relative's diagnosis rule.

Supplemental MRI for high-risk individuals

Coverage/stakeholder guideline alignment and indications inferred from cited society guidance

High-risk screening MRI: Breast MRI (including abbreviated MRI) is usually appropriate for high-risk women (e.g., BRCA mutation carriers, history of chest irradiation, lifetime risk ≥20%), regardless of breast density; when MRI is contraindicated or not possible, CEM or ultrasound may be considered.

ACR/ASBrS guidance; see referenced society guidelines

Adjunctive testing in average-risk women with dense breasts

Adjunctive screening in average-risk women with dense breasts

Average-risk dense-breast supplemental screening: Do not routinely perform adjunctive tests for asymptomatic, average-risk women with dense breasts unless additional risk factors are present; use shared decision-making and density notification to guide any supplemental testing.

ACOG/ACR guidance recommends against routine adjunctive testing in asymptomatic average-risk women with dense breasts

Diagnostic imaging after screening recall

Imaging for diagnostic work-up after recall

Preferred modalities for recall evaluation: For individuals recalled after screening mammography, contrast-enhanced mammography (CEM), MRI, digital breast tomosynthesis (DBT), and handheld ultrasound (HHUS) demonstrate high sensitivity; DBT and standard digital mammography (DM) have higher specificity for discriminating benign lesions. Choose modality based on diagnostic context and availability.

Pooled results from Akwo et al. and systematic reviews; consider modality performance and recall context

Not established for routine screening (emerging/investigational modalities)

Emerging or investigational modalities

CBBCT, MRE, MBI/BSGI, scintimammography: Cone-beam breast CT (CBBCT), magnetic resonance elastography (MRE), molecular breast imaging/BSGI, scintimammography, and similar novel modalities currently have limited or inconclusive evidence to support routine screening use; these modalities are considered unproven or not medically necessary for routine screening pending larger, higher-quality studies.

Multiple systematic reviews and evidence assessments indicate limited or inconclusive evidence

MRI screening: high risk and dense-breast criteria — Covered when ALL of the following are met

Covered when ALL of the following are met (policy revision emphasizes MRI coverage for high-risk and dense-breast individuals):

High-risk or dense-breast MRI criteria: Member meets at least one high-risk criterion (e.g., pathogenic/likely pathogenic germline mutation such as BRCA1/2 or other listed genes with specified start ages; prior chest irradiation between ages 10–30; estimated lifetime risk ≥20% by validated family-history-based models; personal history of breast cancer without bilateral mastectomy; defined family history patterns) OR has heterogeneously or extremely dense breasts (Category C or D) and is aged ≥40.>=40 years for density-based criterion; >=20% lifetime risk for model-based criterion

Screening may begin at the listed age or 10 years prior to the age at diagnosis of the youngest affected relative (up to third-degree relatives), whichever comes first, but not before age 25.

Supplemental screening alternatives (society guidance summarized)

Supplemental screening considerations (society guidance summarized):

Alternative or supplemental modalities: For individuals at increased risk who cannot undergo MRI, consider contrast-enhanced mammography (CEM) or molecular breast imaging (MBI); whole-breast ultrasound may be used if contrast-enhanced or functional imaging is not available or accessible. Counsel patients on benefits and risks including increased recalls/biopsies and contrast reactions for CEM.

NCCN, EUSOBI, SNMMI/EANM guidance; consider availability and contraindications

The policy identifies several alternative breast imaging technologies as unproven and not medically necessary because available studies are small, uncontrolled, or at high risk of bias and have not demonstrated impact on patient outcomes. Examples explicitly listed include Computer‑Aided Tactile Breast Imaging, where evidence is limited to very low‑quality uncontrolled studies with bias and unclear outcome benefit, and dedicated breast CT techniques, which currently lack sufficiently validated, well‑controlled evidence to support routine screening use.

The American College of Radiology (ACR) has reviewed molecular breast imaging techniques and notes insufficient evidence to support routine screening use. Because BSGI/MBI is associated with a relatively high radiation dose and lacks sufficient evidence of benefit as a screening tool, the ACR recommends against its use for screening purposes.

The policy revision clarifies that breast MRI performed for individuals who do not meet the policy’s listed criteria is considered unproven and not medically necessary. Requests for MRI must be supported by documentation showing the patient meets one of the specified high‑risk or density‑based indications; absent that, MRI for screening will be treated as not medically necessary.

Several novel or alternative imaging modalities are addressed as investigational or not supported for routine screening due to limited, heterogeneous, or low‑quality evidence. These include dedicated cone‑beam or other CT of the breast (CBBCT), magnetic resonance elastography (MRE), molecular imaging techniques such as molecular breast imaging (MBI/BSGI) and scintimammography, and positron emission mammography (PEM). Systematic reviews and evidence assessments consistently call for larger prospective studies before these modalities can be recommended for routine screening use.

Dedicated breast CT (CBBCT) and molecular imaging approaches do not yet have sufficient evidence to support routine screening. Systematic reviews indicate diagnostic performance data are limited, heterogeneous, and often from small single‑center studies; existing assessments (including ECRI and other reviews) conclude that evidence is inconclusive and additional well‑designed prospective studies are needed before CBBCT or molecular imaging can be adopted for population screening.

The policy update explicitly lists services that are considered unproven or not medically necessary. These services include MRI of the breast for individuals who do not meet the policy criteria, Computer‑Aided Tactile Breast Imaging, CT of the breast (including CBBCT), Magnetic Resonance Elastography (MRE), and molecular breast imaging techniques such as BSGI/MBI, scintimammography, and PEM.

Covered Indications for Breast Imaging

Breast MRI for screening in high-risk individuals (top-level node)

Breast MRI for screening in high-risk individuals

MRI screening indications: Includes heterogeneously or extremely dense breasts (Category C/D) starting at age 40; prior chest radiation between ages 10–30 (start at 25 or 8 years after treatment); lifetime risk ≥20% by validated models; personal history of breast cancer (unless bilateral mastectomy); specified pathogenic genetic variants with specified start ages; defined family history patterns.

Screening MRI for high-risk patients (top-level node)

Screening MRI for high-risk patients

High-risk MRI screening indication: Women with BRCA mutation, other high-penetrance germline mutations, history of chest irradiation, or lifetime risk ≥20% should undergo MRI screening (including abbreviated MRI) as recommended by ACR/ASBrS; MRI is usually appropriate regardless of breast density.>=20% lifetime risk or qualifying history

Procedure Codes and Coding Notes

Applicable procedure codesmixed

0422T	Tactile breast imaging by computer-aided tactile sensors, unilateral or bilateral.
0633T	Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material.
0634T	Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s).
0635T	Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast, followed by contrast material(s).
0636T	Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s).
0637T	Computed tomography, breast, including 3D rendering, when performed, bilateral; with contrast material(s).
0638T	Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast, followed by contrast material(s).
76376	3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation.
76377	3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation.
76391	Magnetic resonance (e.g., vibration) elastography.

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Device and modality regulatory notes (no specific billing codes listed in this part)mixed

No codes listed

inv-16: Lifetime risk threshold for MRI (>= 20%)

Lifetime risk threshold>= 20%

Risk models referencedGail, Claus, Tyrer-Cuzick, BRCAPRO

Screening start age for this criterionScreening beginning at age 40

inv-17: Lifetime risk threshold (>= 20% — models dependent on family history)

Policy lifetime risk threshold>= 20% (models largely dependent on family history)

Example modelsGail, Claus, Tyrer-Cuzick, BRCAPRO

Provider Actions, Prior Authorization, and Documentation

Billing Rule

Code Listing and Authorization Note

The following procedure and diagnosis codes are provided for reference only and inclusion does not guarantee coverage, authorization, or reimbursement. Benefit coverage is determined by the member-specific benefit plan document and applicable law. Documentation may be required to demonstrate that the member meets the policy criteria; submission of records does not guarantee coverage. Coding clarification: Computer-aided detection (CAD) is included with breast MRI CPT codes 77048 and 77049; no additional reimbursement will be allowed when CAD is performed with these codes.

CPT: 0422T, 0633T–0638T, 76376, 76377, 76391, 76498, 77046–77049
HCPCS: S8080

Denial Risk

Denial Trigger for MRI Without Meeting Criteria

Prior Authorization Highlights

Prior Authorization

MRI coverage depends on member benefit and documentation; codes may need prior authorization

Coverage for MRI is subject to the member's benefit and required documentation; the policy lists codes that may be subject to prior authorization per plan terms.

Coverage is determined by the member‑specific benefit plan; codes in the policy are for reference and may require prior authorization.
Inclusion of a code does not guarantee coverage or payment.

Prior Authorization

Screening MRI usually requires prior authorization if patient does not meet high‑risk criteria

Screening breast MRI typically requires prior authorization when performed for patients who do not meet the policy's high‑risk criteria or when provided outside guideline indications; follow plan authorization procedures and provide supporting clinical documentation.

ACR: MRI usually appropriate for high‑risk women; for others, prior authorization is commonly required.
Provide documentation of qualifying risk factors when requesting authorization for screening MRI.

Contrast and Modality-specific Considerations

Billing Rule

MRI breast contrast codes (77048/77049) include CAD — no separate CAD reimbursement

MRI breast CPT codes 77048 and 77049 describe MRI without and with contrast and include computer‑aided detection (CAD); CAD included in these codes is not separately reimbursable.

77048/77049 include CAD (real‑time lesion detection, characterization and pharmacokinetic analysis) when performed.
Do not bill separately for CAD when billed with 77048 or 77049.

Billing Rule

CE‑CBBCT shows higher sensitivity/specificity in limited studies but evidence insufficient for routine use

Contrast‑enhanced cone‑beam breast CT (CE‑CBBCT) has demonstrated higher pooled sensitivity and specificity than non‑contrast CBBCT in small studies, but protocols varied and evidence remains insufficient to support routine use.

CE‑CBBCT pooled sensitivity ~0.899 and specificity ~0.788 in limited studies; additional large prospective studies are needed.
Consider evidence limitations and protocol heterogeneity before using CE‑CBBCT for screening or routine practice.

Screening Intervals and Frequency Limits

inv-45: screening breast MRI interval recommendation (every 2-4 years)

Recommended interval (EUSOBI)Every 2–4 years for screening breast MRI in women aged 50–70 with extremely dense breasts

RationaleEUSOBI: MRI can reduce breast cancer mortality and is cost-effective in this group

Shared decision-makingWomen should be counselled on benefits and risks to make informed choice

inv-46: breast MRI frequency (every 2-4 years)

Policy frequency limitScreening breast MRI: every 2–4 years

EUSOBI target age groupWomen aged 50–70 with extremely dense breasts (recommendation source)

Services Considered Not Covered / Not Medically Necessary

The policy identifies a set of services that are not covered when used for routine screening or when policy criteria are unmet. These include breast MRI performed without meeting the listed indications, computer‑aided tactile breast imaging (CPT 0422T), computed tomography of the breast (including CBBCT; CPT 0633T‑0638T), magnetic resonance elastography (CPT 76391), and molecular imaging procedures such as BSGI/MBI and scintimammography (e.g., S8080).

Routine use of cone‑beam or dedicated breast CT (CBBCT) for population screening is not supported by current evidence and is considered not covered. Published systematic reviews and technology assessments report limited, heterogeneous data and conclude that CBBCT lacks validated clinical utility for screening at this time; further well‑designed prospective studies are required.

Professional society guidance (ACR) has advised against the use of BSGI/MBI for screening, citing a relatively high radiation dose and insufficient evidence of benefit. Accordingly, BSGI/MBI for routine breast cancer screening is not covered.

Additional items listed as not covered include emerging or investigational breast imaging technologies that lack sufficient evidence for routine screening or for demonstrating clinical benefit. Examples enumerated in the policy include magnetic resonance elastography (MRE), positron emission mammography (PEM), and other molecular imaging techniques when used as primary screening rather than in selected diagnostic contexts.

Definitions and Terms

inv-31: Breast Composition Categories (BI-RADS A-D)

Category AAlmost entirely fatty

Category BScattered areas of fibroglandular density

Category CHeterogeneously dense

Category DExtremely dense

inv-32: Molecular Breast Imaging (MBI) / BSGI definition

DefinitionMolecular Breast Imaging (MBI) / Breast-Specific Gamma Imaging (BSGI) uses radiotracers and a gamma camera to perform functional imaging that detects areas of increased tracer uptake in the breast (also called scintimammography).

Typical tracer

Background and Evidence Summary

Background: Mammography (digital mammography and digital breast tomosynthesis) remains the generally accepted standard for population breast cancer screening and diagnostic work‑up. Additional modalities such as ultrasound and breast MRI are used selectively based on individual risk, breast density, or diagnostic need. Emerging technologies exist, but the policy notes that many have limited or low‑quality evidence and are considered investigational or not medically necessary for routine screening until higher‑quality outcome data are available.

Policy Summary

Payersierra health and life

PolicyBreast Imaging for Screening and Diagnosing Cancer

Policy CodePolicy 2026T0375LL

Change TypeRevised coverage criteriaadded definitionsclarified screening age rules

Effective DateFeb 1, 2026

Next Review Date

Key ActionObtain and document risk assessment, breast density, and supporting evidence when requesting prior authorization for screening breast MRI.

SourceLink

On This Page

Consider supplemental imaging (MRI/US) in selected subgroups (top-level node)

Consider supplemental imaging (MRI/US) in selected subgroups

Supplemental imaging to reduce interval cancer rate: Supplemental MRI or ultrasound can increase cancer detection and may reduce interval cancer rates in selected subgroups (e.g., high-risk women, women with dense breasts), but they also increase recall and biopsy rates; weigh benefits and harms when selecting supplemental screening.

Systematic review evidence; incremental CDR for supplemental MRI 14.2–16.5 per 1000 screens

Screening and supplemental imaging indications (3 top-level nodes)

Screening and supplemental imaging indications

Indication: screening MRI for very high-risk genetic carriers: Women aged ≥25 with BRCA gene mutation or other high-penetrance germline mutations should be offered screening MRI (start ages specified per gene, e.g., BRCA at 25).>=25 years for BRCA carriers

Indication: MRI for high estimated lifetime risk: Women with estimated lifetime risk ≥20% based on family-history-based models are candidates for MRI screening (policy uses ≥20%).>=20% lifetime risk

Indication: dense-breast supplemental MRI: Women with heterogeneously or extremely dense breasts may be offered screening breast MRI; EUSOBI specifically recommends offering MRI every 2–4 years for women aged 50–70 with extremely dense breasts; policy adds Category C or D density with screening beginning at age 40.age 40 (policy) or 50–70 (EUSOBI)

Society guidance alignment

ASBrS supports MRI for women with 20%-25% or greater estimated lifetime risk

Requests for breast MRI that do not meet the policy’s defined high‑risk or other covered criteria (e.g., individuals who do not meet any listed genetic, familial, prior chest RT, or calculated lifetime-risk thresholds) are considered unproven or not medically necessary and may be denied. Denials may be issued when documentation fails to demonstrate the member meets required age, risk, or breast composition thresholds specified in the policy.

MRI of the breast for individuals who do not meet the criteria listed in the policy is considered not medically necessary
Requests lacking required supporting medical records or risk assessment documentation may be denied

Documentation Required

Risk Assessment and Density Counseling

Document the patient’s formal breast cancer risk assessment and any breast density counseling in the medical record. The risk assessment should identify genetic mutations, family history details (including ages at diagnosis and degree of relation), lifetime-risk model results (Gail, Claus, Tyrer‑Cuzick, BRCAPRO, or similar), history of chest radiation, and prior personal history of breast disease. Counsel and record the discussion of breast density and supplemental screening options (benefits, risks, and alternatives) when applicable.

Document risk-assessment method and numerical lifetime-risk estimate when used
Record breast density category (A–D) and counseling provided to the patient

Note

Plan Document Governs

The member-specific benefit plan document controls coverage determinations. This policy is a guideline to assist in interpretation of UnitedHealthcare standard benefit plans but does not supersede the member’s plan contract. Check the member’s plan and any applicable federal or state mandates prior to authorization or claims processing.

In the event of conflict between this policy and the member-specific benefit plan document, the member-specific benefit plan governs
Verify plan benefits and any applicable mandates before approving services

Prior Authorization

Sequence of Diagnostic Modalities for Recall

For diagnostic work‑up following a screening recall, perform standard conventional imaging and targeted diagnostic mammography/tomosynthesis and ultrasound as clinically indicated prior to or in conjunction with advanced adjunctive modalities. Advanced adjuncts (e.g., contrast-enhanced mammography, MRI, or molecular imaging) are generally considered after initial conventional diagnostic evaluation when results remain inconclusive or when indicated by clinical risk.

Conventional diagnostic imaging (mammography/DBT and targeted ultrasound) should be completed prior to advanced adjunctive testing for recall evaluations
Use CEM, MRI, or other advanced modalities when conventional imaging is inconclusive or when clinical risk/indication supports further evaluation

Prior Authorization

Authorization Guidance and Prior Authorization for Screening MRI

This policy provides guidance on criteria used to determine medical necessity for breast MRI and related services. Authorization requirements, documentation expectations, and coverage decisions should align with the criteria in this policy and the member’s plan. Prior authorization may be required for screening MRI in patients meeting high‑risk criteria—confirm plan-specific prior authorization requirements before scheduling.

Prior authorization may be required for screening MRI in high‑risk patients (e.g., BRCA mutation carriers, lifetime risk ≥20%, prior chest RT)
Services not meeting policy criteria may be labeled not medically necessary and denied

Prior Authorization

Authorize breast MRI when required by the member's benefit plan and document medical necessity

Breast MRI requires authorization when the member's benefit plan mandates it; medical necessity must be documented per the policy criteria (risk model results, family history, breast density, genetic test results).

Policy criteria (e.g., lifetime risk ≥20%, specified genetic mutations, density categories) should be documented to demonstrate medical necessity.
Check the member‑specific plan for prior authorization requirements and submit required evidence.

Billing Rule

CEM uses iodinated contrast — consider contrast reaction risk when chosen as MRI alternative

Contrast‑enhanced mammography (CEM) uses iodinated contrast and carries the risk of contrast reactions; consider this risk when selecting CEM as an alternative to MRI for supplemental screening.

NCCN: CEM increases cancer detection but carries risk of iodinated contrast reactions; limited data exist for routine screening.
Document contraindications and discuss contrast reaction risks with patients when considering CEM.

Availability and quality-assurance considerations may limit immediate implementation

Tc-99m sestamibi (examples cited in literature)

Performance noteSystematic reviews report sensitivity ~85% and specificity ~83–86%; higher specificity than MRI but associated with higher radiation dose

inv-33: Computer-Aided Tactile Breast Imaging definition

DefinitionComputer-Aided Tactile Breast Imaging involves a hand-held tactile array sensor moved across the breast to generate multi-dimensional images showing size, shape, hardness, and location of suspicious masses.

TechniqueSensor data are processed into color images in real time for clinician interpretation

Evidence statusConsidered unproven/not medically necessary for routine screening per policy due to limited evidence

inv-34: Magnetic Resonance Elastography (MRE) definition

DefinitionMagnetic Resonance Elastography (MRE) of the breast is a phase-contrast MRI technique that quantifies tissue stiffness (elastic modulus) to differentiate malignant from normal tissue.

Physiologic basisBreast cancers typically have elastic modulus ~5–20x higher than surrounding fibroglandular tissue

Clinical statusFeasibility demonstrated but clinical diagnostic benefit remains under evaluation; not established for routine screening

inv-35: Positron Emission Mammography (PEM) definition

DefinitionPositron Emission Mammography (PEM) is a high-resolution metabolic imaging technique for the breast using an FDG tracer with detectors integrated into a mammography system.

AcquisitionEmission images are acquired immediately after the mammogram, providing metabolic information

Policy statusConsidered unproven/not medically necessary for routine screening absent criteria

inv-36: Magnetic Resonance Elastography (MRE) additional note

Additional noteMRE quantifies tissue stiffness and can depict elastic properties of breast tumors, but further research is needed to define clinical applications for diagnosis or screening.

LimitationsNo diagnostic conclusion beyond relative stiffness can currently be made; clinical benefit under evaluation

inv-37: Cone-beam breast computed tomography (CBBCT) definition

DefinitionCone-beam breast computed tomography (CBBCT) is a dedicated breast CT technology (non-contrast or contrast-enhanced) under investigation for breast imaging.

PerformanceSmall studies show CE-CBBCT may have sensitivity and specificity comparable to MRI, but evidence is limited and heterogeneous

Policy stanceRoutine use for screening is not supported by current evidence

inv-38: MBI/BSGI additional definition and performance note

Additional definition and noteMBI/BSGI (scintimammography) uses radiotracers (e.g., Tc-99m sestamibi) and a gamma camera to detect malignancy; systematic reviews report sensitivity similar to MRI but higher specificity.

Trade-offHigher specificity comes with a higher radiation burden, which factors into ACR recommendations against routine screening use

Clinical roleMay be useful as adjunct to mammography for diagnostic evaluation of suspicious lesions rather than primary screening in average-risk women

inv-39: Breast Composition Categories (added to policy definitions; C/D refer to heterogeneously/ extremely dense)

Definition added to policyBreast Composition Categories (ACR BI-RADS): A = Almost entirely fatty; B = Scattered fibroglandular density; C = Heterogeneously dense; D = Extremely dense.

Policy emphasisPolicy notes Category C (heterogeneously dense) and Category D (extremely dense) as criteria for MRI screening starting at age 40

Clinical implicationBreast density reduces mammography sensitivity and is an independent risk factor for breast cancer

inv-40: High risk for breast cancer — definition including BRCA and other germline mutations

High-risk definition examplesIncludes BRCA1/BRCA2 mutation carriers and other germline mutations known to predispose to high breast cancer risk (e.g., PALB2, PTEN, CHEK2, ATM, BARD1, CDH1, NF1)

Lifetime risk modelsPolicy uses lifetime risk >=20% (models largely dependent on family history) to define high risk

Other high-risk conditionsPrior chest irradiation between ages 10–30; personal history of breast cancer without bilateral mastectomy