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A recent JAMA Onc pub reports on 754 women ≤50 years with breast cancer who were prospectively surveyed following their breast conserving surgeries with all three screening modalities annually for three years: mammogram (MMG), MRI and ultrasound (US). Overall 17 second cancers were detected, with MRI doubling the sensitivity of MMG alone. So what does this change? Currently the American Cancer Society recommends screening MRI only for women with a known genetic mutation carrying at least a 25% risk of a second cancer (remember: all of these women should have been tested for a BRCA mutation if ≤45 or with even one family member with breast, pancreatic or prostate cancer). So even if your patient doesn’t have a known mutation, if she also doesn’t have at least five decades of life under her belt, she probably merits MRI screening as secondary prevention.