In 2007, the American Cancer Society published guidelines for using breast MRI to screen women who were at high risk for breast cancer. Although breast MRI, which is typically used as an adjunctto mammography, is highly sensitive for detecting breast cancers, its use is somewhat controversial for a number of reasons including its cost and lack of specificity. This article describes the indications for breast MRI and discusses the pros and cons of using it to screen women for cancer and evaluate the extent of disease in women who are newly diagnosed.