I have a 79 year old female that was just diagnosed with ALH on breast biopsy - her scores are as follows:

Modified Gail Model: Five Year is: 3.2 %, compared to 2.1% for an average risk peer.
Tyrer-Cuzick v 8 8.9% lifetime risk compared to 2% for an average risk peer.

She had lung cancer herself at the age of 57 incidentally found s/p surgical resection only- RUL
Has a fib and on Eliquis BID
category B dense breasts
No family history of breast cancer

My Questions for the experts:
1. Given her age, would you recommend any risk reducing meds due to the ALH? she has osteopenia and therefore I was considering raloxifene and given she is on eliquis that would minimize clot risk

2. Would you recommend breast MRI for her given she has category B dense breasts and lifetime risk < 20% ?
If no risk reducing meds would MRI be more important?

Expert Response: 1) Agree, given the patients age, we would not recommend risk reducing meds. 2) With a B density, we would not recommend Breast MRI even though she has ALH. Bilateral 3D screening mammogram annually is appropriate, even if she is not a candidate, given her age, for risk reducing medications.