Reimbursement Information from Specific Insurers

 Women at high risk for developing breast cancer.  Gene mutation carriers (BRCA 1 & 2)  1 degree relative of BRCA carrier, but untested  20-25% lifetime risk due to family history  Radiation to chest between ages 10-30 years  Women with a metastatic axillary node adenocarcinoma with an unknown primary.  Rare <1% breast cancers  Typically from ipsilateral breast and not identified on clinical breast exam or mammography  Follow up during chemotherapy: used to monitor neoadjuvant chemotherapy response on locally advanced breast cancer.  For women as contralateral screening with newly diagnosed breast cancer.  MRI may detect synchronous incidental occult breast cancer  Most studies report rates of 4-6%  To perform pre-operative staging for breast carcinoma.  Determine extent of tumor (avoid positive surgical margins)  Determine lymph node, chest wall and pectoralis muscle involvement  Multifocal (within the same quadrant) vs multicentric (within different quadrants)  MRI is more sensitive than mammography and ultrasound in determining the extent of known carcinoma  Median prevalence of detection of additional foci of cancer in the ipsilateral breast is 16%  Especially important for young patients, in patients with dense or moderately dense breasts and patients with infiltrating lobular carcinoma (difficult to detect on mammography)  Women with a personal history of breast cancer.  Patients are at an elevated risk and early detection of second cancers is known to decrease mortality  Ordered at the discretion of the clinician and patient in young patients, dense breasts mammographically occult cancer or suspected recurrence  Problem solving for mammography and ultrasound equivocal cases.  Women with positive margins following an initial attempt at breast conservation to detect residual disease.