Magnetic resonance imaging enables high definition scanning of tissue without the use of ionising radiation. In the past decade it has become widely used in breast imaging and is a sensitive method of visualising the breast parenchyma and highlighting areas of pathology. Magnetic resonance mammography is now the optimum imaging modality when combined with mammography and ultrasound for screening women at high risk as a result of genetic abnormalities that predispose them to breast cancer.1 The technique can detect occult carcinoma not seen with conventional imaging; it is a useful imaging tool for patients who present with metastatic axillary lymphadenopathy and an occult primary tumour in the breast; and it is useful when assessing response to neoadjuvant chemotherapy. However, its routine use in the management of patients with early stage breast cancer may be unwarranted—we have no evidence to support a clear benefit in this setting⇓.

The Comparative Effectiveness of Magnetic Resonance Imaging in Breast Cancer (COMICE) trial was a multicenter randomised controlled trial conducted in the United Kingdom to assess the impact of magnetic resonance mammography in patients with breast cancer who …