Imaging Centers Are Ideally Positioned for Breast & Hereditary Risk Assessment 

Early cancer detection through advanced imaging remains a cornerstone of breast cancer care. Identifying high-risk patients is crucial for implementing personalized screening protocols that can significantly improve early detection rates and allow for interventions that may reduce risk. Yet, concerning gaps persist in our healthcare system: 

• 93% of women who qualify for high-risk breast MRI based on medical and family history never receive this critical screening.¹^,² 
• Approximately 5% of individuals have a mutation in a cancer predisposition gene, with most unaware of their status.³ 

A Significant Opportunity for Imaging Centers 

Mammography centers represent an untapped opportunity for comprehensive risk assessment. With mammography screening adherence between 76% and 81%, these centers have unparalleled access to a broad population that could benefit from comprehensive risk stratification.⁴ 

A landmark study published in 2021 demonstrated the feasibility and effectiveness of implementing population screening for personal and family history risk factors in mammography centers, establishing these facilities as ideal settings for identifying at-risk individuals.⁵ 

This aligns with professional society recommendations. The American Society of Radiologic Technologists Practice Standards emphasize that “medical imaging professionals are the primary liaison between patients, licensed practitioners and other members of the healthcare team” and “must remain sensitive to the needs of the patient through communication, assessment, monitoring and patient care.”⁶ Similarly, the American College of Radiology advocates for imaging centers to implement protocols that effectively assess patient risks.⁷ 

Current Limitations in Risk Assessment 

Common approaches to identifying high-risk patients face significant limitations. Many imaging centers don’t calculate breast cancer risk scores for every patient, leading to under-identification of women who would benefit from supplemental screening with breast MRI. 

The identification of patients who qualify for genetic testing is equally problematic. Paper-based family history collection is often inconsistent, incomplete, and difficult to analyze against complex and evolving genetic testing guidelines.⁸^,⁹ This challenge is compounded by the nationwide shortage of genetic professionals.¹⁰ 

Digital Solutions Make Universal Risk Assessment Possible 

The Ambry CARE Program® (CARE) addresses both breast cancer and hereditary cancer risk evaluation simultaneously—identifying patients who qualify for breast MRI and those who meet criteria for genetic testing. 

A study presented at the San Antonio Breast Cancer Symposium demonstrated CARE’s impact when implemented across multiple centers with 250,000 female patients:¹¹ 

• One in 10 received recommendations to update their cancer risk management plans. 
• 13% had elevated Tyrer-Cuzick scores qualifying them for breast MRI. 
• 32% met criteria for hereditary cancer testing. 
• Among those who tested positive, 42% of cases included direct impact on breast care recommendations. 

Comprehensive Support Beyond Risk Assessment 

CARE provides an end-to-end solution that includes: 

• Risk identification: Tyrer-Cuzick breast cancer risk score and hereditary risk assessment is weighed against NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)¹²,¹³ 
• Patient education: Digital resources explaining genetic concepts and testing outcomes 
• Genetic test coordination: Streamlined genetic testing offered by Ambry Genetics 
• Results delivery: Secure delivery through appropriate channels (provider, platform, or genetic counseling) based on result type and center preferences 
• Post-test genetic counseling: Connection to telehealth counseling at no cost to patients 

The Path Forward 

For imaging centers considering implementation of risk assessment, digital solutions like the Ambry CARE Program offer scalable options that integrate into existing workflows. With such tools, imaging centers can lead the transformation from reactive to proactive care, ensuring patients receive appropriate MRI screening and access to genetic testing and counseling when indicated. Learn more here.

References: 

1. Miles R, et al. (2018). https://pmc.ncbi.nlm.nih.gov/articles/PMC6007803/ 
2. Hill, D. A., et al. (2018). https://doi.org/10.1007/s11606-017-4224-6 
3. Caswell-Jin, J. L., et al. (2019). https://doi.org/10.1093/jnci/djy147 
4. Narayan AK, et al. (2020). https://doi.org/10.1016/j.jacr.2019.11.004 
5. Kurian AW, et al. (2021). PMID: 34424535 
6. American Society of Radiologic Technologists. (2024). Practice Standards. https://www.asrt.org/main/standards-and-regulations/professional-practice/practice-standards-online 
7. American College of Radiology. (2024). https://www.acr.org/Data-Science-and-Informatics/AI-in-Your-Practice/AI-Use-Cases/Use-Cases/Breast-Cancer-Risk-Assessment 
8. Wildin, R. S., et al. (2021). https://doi.org/10.1007/s12687-021-00531-6 
9. Spector-Bagdady, K., et al. (2022). https://doi.org/10.1001/jamanetworkopen.2022.33157 
10. Berninger, T., et al. (2021). https://pubmed.ncbi.nlm.nih.gov/33124158/ 
11. Fecteau, H., et al. (2022, December). Poster presented at the SABCS. 
12. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate. V3.2025. ©National Comprehensive Cancer Network, Inc. 2025. All rights reserved. Accessed April 2, 2025. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.  
13. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric. V4.2024. ©National Comprehensive Cancer Network, Inc. 2025. All rights reserved. Accessed April 2, 2025. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.