Abstract Introduction: Recent randomized controlled trials (RCTs) of breast MRI combined with mammography among high-risk women resulted in fewer interval breast cancer (BC) cases and earlier cancer detection compared to mammography alone. Despite this finding, supplemental breast MRI is underutilized. We aimed to identify factors associated with the receipt of supplemental breast MRI in a racially/ethnically diverse population of high-risk women. Methods: We conducted a retrospective cohort study among high-risk women undergoing screening mammography at Columbia University Irving Medical Center (CUIMC) in New York, NY, from 2007-2024. BC risk categories were classified based upon ICD-9/10 diagnostic codes or findings from breast radiology/pathology reports: 1) at high risk for BC, 2) family history of BC, 3) extremely dense breasts, 4) high-risk breast lesion (atypical hyperplasia AH or lobular carcinoma in situ LCIS), and 5) genetic predisposition for BC. Patients with a diagnosis of BC prior to 2007 were excluded. We collected information on demographic and clinical characteristics in the electronic health record (EHR), including age, race, ethnicity, primary health insurance, body mass index, mammographic density (BIRADS classification), benign breast biopsies, and family history of BC. Our primary outcome was receipt of supplemental breast MRI based upon radiology reports in the EHR. A multivariable logistic regression model was used to determine the association between breast MRI receipt and demographic and clinical characteristics. Results: Of the 54,122 women included in our analysis, the mean age was 58 years (SD, 10), including 29.0% non-Hispanic White women, 34.0% Hispanic, 12.0% non-Hispanic Black, 3.9% Asian, and 5.1% other or multiracial. In terms of BC risk factors, 4.5% of the women had extremely dense breasts, 16.0% had a family history of BC, 2.0% had AH or LCIS, and 1.6% had a genetic predisposition for BC. Overall, only 3.6% of women received a supplemental breast MRI. In multivariable analysis, younger age was significantly associated with breast MRI receipt, with women aged 25-34 demonstrating higher odds of undergoing supplemental breast MRI (odds ratio OR=2.59; 95% confidence interval CI=1.77-3.72) compared to those aged 45-54. Compared to non-Hispanic White women, Asian and Hispanic women had significantly lower odds of receiving a breast MRI (OR=0.72, 95% CI=0.63-0.82 and OR=0.66, 95% CI=0.51-0.84, respectively). Having extremely dense vs. less dense breasts on mammography (BIRADS D vs. B) was associated with higher breast MRI uptake (OR=1.99, 95% CI=1.35-2.92). Compared to women with a diagnostic code for at high risk for BC, those in other risk categories had significantly higher odds of receiving a screening breast MRI: family history of BC (OR=7.14, 95% CI=6.36-8.02), genetic predisposition to BC (OR=26.6, 95% CI=22.30-31.70), and high-risk breast lesions (OR=28.1, 95% CI=23.70-33.30). We did not observe differences in breast MRI use among Black vs. White women or based upon health insurance status (private vs. public). Conclusion: In a racially/ethnically diverse cohort of women at high risk for BC, only 3.6% received a supplemental breast MRI. Utilization varied significantly by age, race/ethnicity, and specific BC risk factors. These findings highlight persistent gaps in the uptake of guideline-concordant supplemental BC screening. We plan to study the impact of breast MRI use on early detection of local disease and screen-detected vs. interval BC. Future research should investigate patient-, provider- and system-level barriers to adoption of supplemental breast MRI among high-risk women to promote equitable access to advanced screening modalities. Citation Format: A. Michel, J. Zahlan, K. D. Crew. Factors Associated with Receipt of Magnetic Resonance Imaging for Breast Cancer Screening Among Racially/Ethnically Diverse High-Risk Women abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-06-04.
Michel et al. (Tue,) studied this question.