Hughes RiskApps can increase MRI volume significantly, while making each MRI more likely to be
approved
Screening MRI of the breast is recommended for women meeting the American cancer Society guidelines
developed by Saslow et al in 2007 (Saslow). The most applicable and yet poorly applied of these
guidelines is the following:
"Lifetime risk ~20–25% or greater, as defined by BRCAPRO or other models" (Tyrer Cuzick or Claus )
"that are largely dependent on family history"
In the November, 2013 issue of JAMA Internal Medicine, an Article by Stout and an article by Wernli
reported on the large number of women needing breast MRI screening who were not getting it, and the
large number of women getting breast MRI screening who did not need it.
In an accompanying editorial, Hwang suggests that the use of Hughes RiskApps (HRA) can help to solve
this problem.
Essentially this trio of papers sets the stage for the use of HRA to markedly increase the number of MRIs
done by an Imaging Center, on the patients who need them the most. We would submit that HRA can
also increase your insurance approval rate by automatically generating a Letter of Medical Necessity
describing in detail why each patient specifically fits this ACS guideline.
What makes us different?
We let the patient enter the data thru an easy to use, self administered Tablet or internet based
questionnaire. We then use that data (entered one time) to run all three models accepted by the ACS.
For those patients meeting the guidelines, we automatically generate a letter of medical necessity for the
MRI, increasing the probability that the insurance company will approve the study. In addition, we add
each patient to an MRI queue where compliance can be monitored.
The alternative approach of entering the data 2 or 3 times to run the models is time consuming and
difficult. The results are present only as a screen shot, and must be transcribed to a spreadsheet or other
data repository for monitoring. Generation of LMNs must be done manually for each patient.
Wernli Quotes with comment
"The rate of screening breast MRI increased more than 4-foldbetween 2005 and 2007 from 0.8 to 3.4 per 1000women and then remained fairly
stable at 4.3 breast MRI examinations per 1000 women in 2009."
o
Our data suggests that the rate of screening MRI should be closer to 58 per 1000 women screened (Ozanne)
"Among women who received screening breast MRI, 25% had a more than 20% lifetime risk of developing breast cancer according to the
BCRAT model"
o
Wernli, in essence, suggests that 75% of those getting MRI do not meet the guidelines

That only 1 per 1000 women getting a screening MRI actually meet the guidelines

Again our data suggests that 58 women per 1000 would get an MRI if the guidelines were followed.
o
Use of HRA would increase appropriate MRI use by 5800%
o
Use of HRA would decrease the inappropriate use of MRI by about 75%
Stout Quotes with comment
"By 2011, screening was the leading breast MRI indication, at 32.3 per 10 000 women"
o
That translates to a number similar to Wernli, 3.23 per 1000 women

Our data suggests that the rate of screening MRI should be closer to 58 per 1000 women screened (Ozanne)
" Among women in the HPHC–Atrius Health subgroup who underwent at least 1 screening or surveillance breast MRI, we found that 21.0% (90
of 429) had family history documentation and/or positive mutation status in their medical records supporting a lifetime risk greater than 20%."
o
Similar to Wernli, Stout, in essence, suggests that 79% of those getting MRI do not meet the guidelines
o
o

That less than 1 per 1000 women getting a screening MRI meet the guidelines

Again our data suggests that 58 women per 1000 would get an MRI if the guidelines were followed.
Use of HRA would decrease the inappropriate use of MRI by close to 90%
Use of HRA would increase appropriate MRI use by over 5800%
"Only 3.5% of women had a deleterious genetic mutation for breast cancer noted in medical claims"..." Nearly half of the women with a mutation
noted (180 of 372) underwent MRI for screening."
o
Unfortunately, this means that over half the mutation carriers did NOT get MRIs, against the ACS guidelines.
o
HRA can track mutation carriers to confirm they get the MRIs needed
o
In addition, HRA can find more patients who are eligible
Hwang quotes:
"Increasingly sophisticated electronic clinical tools will help in this process—1 example among several is the Hughes RiskApps
(http://www.hughesriskapps.com), a web-based tool that allows calculation of lifetime breast cancer risk at point of care based on several
validated cancer risk models"
"Incorporation of such tools into screening decisions is 1 critical step toward a more “personalized cancer screening” model in which
recommendations are based on individual cancer risk assessment."
REFERENCES
1. Saslow D, Boetes C, Burke W, et al; American Cancer Society Breast Cancer Advisory Group.American Cancer Society guidelines for breast
screening with MRI as an adjunct to mammography.CA Cancer J Clin. 2007;57(2):75-89.
8. Wernli KJ, DeMartini WB, Ichkawa L, et al. Patterns of breast magnetic resonance imaging use in community practice [published online November
18, 2013]. JAMA Intern Med. doi:10.1001/ jamainternmed.2013.11963.
9. Stout NK, Nekhlyudov L, Li L, et al. Rapid increase in breast magnetic resonance imaging use: trends from 2000 to 2011 [published online
November 18, 2013]. JAMA Intern Med. doi:10.1001/jamainternm5ed.2013.11958.