Improving risk-stratified use of preoperative MRI in young women with breast

This Letter to the Editor critiques Erguven et al.'s single centre study of universal preoperative breast MRI in women 40 years or younger with newly diagnosed breast cancer. We place their findings within mixed evidence on the effect of MRI on re-excision, mastectomy rates and outcomes, and highlight design and reporting limitations that restrict causal inference and generalisability in this young, higher risk population. We then outline priorities for future prospective, risk stratified research and policy, linking MRI use to tumour biology, surgical planning, patient reported outcomes and equity to ensure that expanded imaging leads to better and fairer care.