Recognition of the limitations of mammography in screening women at high risk for breast cancer stimulated clinical trials to evaluate magnetic resonance imaging (MRI) as an adjunct to mammography. Based on the results of these trials, there is increased interest in offering screening MRI to high-risk women after discussion of the potential benefits and risks. The benefits include increased cancer detection with MRI and significantly more cancers detected prior to nodal metastases. The risks include false-positive exams, which lead to additional imaging and/or benign biopsies. This article will review the findings from published clinical trials and provide guidelines for implementation of an MRI screening program.