In high risk women, supplemental screening tests are recommended in addition to mammography. Studies support the use of screening MRI in women who are known to have a very high risk (>20% lifetime or >5% 10-year) of breast cancer, regardless of their breast density. This examination is widely recommended by radiologists.
Other studies have provided support for screening ultrasound for high-risk women, but only for those women with dense breasts who have not had MRI. If a woman has a screening MRI, screening ultrasound will provide no additional benefit. In addition, many centers either do not offer screening ultrasound or offer it with out-of-pocket charges to the patient. Although a more expensive test, screening breast MRI is generally covered for women who are at very high risk. There is no formal recommendation from the radiology community at this point regarding screening ultrasound. Some radiologists are opposed to it, while some believe that it has a role.