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Editor’s note: The COMICE (Comparative Effectiveness of Magnetic Resonance Imaging [MRI] in Breast Cancer) randomized controlled trial was started in 2001 to assess the clinical efficacy and cost-effectiveness of contrast-enhanced MRI in women with primary breast cancer who were scheduled for wide local excision. The aims of the trial were to address the uncertainty regarding preoperative identification of multicentric disease, the role of MRI in clinical management, quality of life (QoL) measures, and patient satisfaction, while incorporating a health economic assessment. In the current article, the authors report the results for the primary endpoint of the trial: the proportion of patients undergoing a repeat operation or further mastectomy within 6 months of randomization, or a pathologically avoidable mastectomy at initial operation. In addition, they provide data on the QoL and health economic assessments.