Background: Mammography is the standard of care for the early detection of breast cancer. Recently, studies have shown that Magnetic Resonance Imaging (MRI) has greater sensitivity in cancer detection. However, there have been reports identifying a high false positive rate. The aim of our study was to determine if breast MRI aids in the detection of new clinically significant disease, even in “low risk” patients, when compared to ultrasound (US) or mammography alone. Methods: A review of all patients who underwent breast MRI under the care of a single surgeon between 1/1/07 through 6/1/11 was conducted. Patients were categorized as high or non-high risk based on a history of breast cancer, genetic mutation, significant family history or >20% lifetime Gail model risk. For this study a clinically significant disease is defined as a new cancer or high-risk lesion that requires close follow-up and monitoring. Results: A total of 163 patients had a breast MRI and all had concerning findings. Compared to US or mammogram, MRI identified new or additional disease that changed plans in 150/159 (94.3%) patients. Of these, MRI added clinically relevant findings in 85 patients (56.7%, p<0.001). In those considered “high risk” MRI detected clinically significant disease in 37/76 (48.7%) and in 46/76 (60.5%) of the non-high risk group. 16 patients were <40 and MRI found new disease in 2/7 (28.6%) high risk patients compared to 3/9 (33.3%) non-high risk patients. 48 patients were 41-50 years old and MRI detected new disease in 12/24 (50%) high risk patients compared to 13/24 (54.2%) non-high risk. Of the 37 patients aged 51-60, MRI found new disease in 11/19 high risk patients (57.9%) compared to 14/18 (77.8%) non-high risk. 50 patients >60 years of age, MRI found new disease in 12/25 (48%) high risk patients compared to 16/25 (64%) who were non-high risk. Conclusions: We confirm that MRI provides extremely relevant data in identifying new or additional disease when compared to US or mammogram. MRI not only aided in finding additional disease in patients that were high risk but more importantly, MRI found pathology-proven new disease in non-high risk patients across all age groups. These results hold a substantial clinical implication in the ability to find new cancers or high-risk lesions early on, especially in non-high risk patients.