A Multi-Modality Surveillance Program for Women at High Risk for Breast Cancer

Inclusion Criteria: \- Known BRCA1 or BRCA2, TP53, PALB2, PTEN, CDH1 and STK11 carrier. Women with pathogenic mutations in any other cancer susceptibility genes are eligible only if they also have a high PRS. OR * With life time risk of 30% or higher, based on Polygenic Risk Score that integrates genetic and non-genetic factors OR * 5-years risk ≥ 6% for women 40-64 OR * 5-years risk ≥ 6% for women 65+ AND breast density C or D AND a lifetime risk \>= 20% (BCSC+PRS LTR or Tyrer-Cuzick LTR) OR * Patients with history of chest wall radiation received before age 35. OR * To promote health equity, women of African Ancestry \< 45 years with at least one 1st or 2nd degree relative with breast or ovarian cancer are eligible because PRS Scores are not currently reported for AA women. * Must be at least 25 years old. * Willing to travel to participating site for imaging studies as well as any necessary follow-up procedures. * Be able to give informed consent. * Patients with prior history of breast or ovarian cancer are eligible if they have completed all active treatments and are cancer free for two years. Exclusion Criteria * Undergoing active cancer treatment at the time of enrollment. * Current pregnancy or plans for pregnancy within two years of enrollment. * Presence of a pacemaker or any other metallic foreign object in their body that interferes with an MRI. * Breast surgery within two weeks of study entry. * Women with history of bilateral mastectomy are not eligible * History of kidney disease or abnormal kidney function. * History of dye allergy unless it can be mediated with antihistamines and/or steroids * Women can be taking hormone replacement therapy, tamoxifen, raloxifene, aromatase inhibitors, Parp Inhibitors as adjuvant therapy or participating in a chemoprevention trial.