How do I identify women who are at higher risk who should have MRI?

The American College of Radiology (ACR) [1] recommends all women, but especially Black women and women of Ashkenazi Jewish descent, undergo risk assessment and possible genetic testing by age 25 to identify those at higher risk who can then be counseled to begin earlier and more aggressive screening for breast cancer. All women benefit most from starting screening at least by age 40, and many women will meet current guidelines for supplemental screening MRI based on consideration of risk factors including age, mammographic breast density, family history of breast cancer, and breast biopsy history. Insurance coverage for screening MRI and risk criteria vary by state.