We read with great interest the article by Folse and colleagues (1). Their conclusion that “risk modeling may provide information that allows stratification of patients by disease risk, with alternate strategies of … screening and/or preventative treatment” has major potential implications. However, care needs to be taken with respect to the specific methods used, potential for acceptance of stratification by all actors (including subjects), and generalizability beyond the United States (as mentioned in the Discussion).

Folse and colleagues assume an interest of alternative screening methods when lifetime risk exceeds 20%, regardless of the reasons for such risk. The only current demonstration of the value of adding MRI to mammography is applicable to genetic high-risk populations, who develop very early, aggressive cancers in dense breasts. This value is related to cancer detection, and as of yet shows no influence on survival. Such benefits may be very different if the...

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