Please answer the following questions:

Do you have:

• a male relative who had breast cancer?
• any relative who had breast cancer before age 50?
• two or more female relatives with breast cancer after age 50?
• a relative with cancer in both breasts or two cancers in one breast?
• a relative who had ovarian cancer?

Are you of Hungarian, Swedish, Icelandic, or Ashkenazi Jewish descent?

Have you or a relative tested positive for the BRCA 1 or 2 gene? (Breast cancer gene)

Have you been diagnosed with:

• ovarian cancer?
• Hodgkin’s lymphoma and been treated specifically with “mantle” radiation to the chest?
• lobular or atypical changes on breast biopsy?

If you answered "Yes" to any of the above questions, you may be at high risk for breast cancer.

If you answered "No" to all of the questions above, please proceed to the National Cancer Institute's Breast Cancer Risk Assessment Tool to calculate your percent lifetime risk of developing breast cancer. If the Breast Cancer Risk Assessment Tool assigns you a lifetime risk of greater than or equal to 20%, you are at high risk for breast cancer.



Criteria for Determining Insurance Coverage for Breast MRI

Each insurance company has its own criteria for determining coverage for screening breast MRI. If you use one of the available calculators for breast cancer risk assessment and your lifetime risk is greater than 20%, most insurance companies will cover your screening. In addition to using one of those calculators, Blue Cross of California will also consider you at high-risk if you meet one or more of the following criteria:

Do you have:

• two or more first degree* relatives diagnosed with breast cancer?
• one first degree and two or more second degree^† relatives diagnosed with breast cancer?
• one first degree diagnosed with breast cancer before age 45 and one other relative with breast cancer?
• one first degree relative with breast cancer and one relative with ovarian cancer?
• two second or third degree^‡ relatives with breast cancer and two or more relatives with ovarian cancer?
• three or more second or third degree relatives with breast cancer?
• one first degree relative with bilateral breast cancer?

*First degree relative - The parents, brothers, sisters, or children of an individual.
†Second degree relative - The aunts, uncles, grandparents, grandchildren, nieces, nephews, or half-siblings of an individual.
‡Third degree relative - The great aunts, uncles, grandparents, grandchildren, nieces, nephews, or first cousins of an individual.