Adding MRI to annual mammography screening improves early breast cancer detection in women with familial risk or BRCA1/2 mutation, but breast cancer specific metastasis free survival (MFS) remains unknown. We compared MFS of patients from the largest prospective MRI Screening Study (MRISC) with 1:1 matched controls. Controls, unscreened if<50 years, and screened with biennial mammography if ≥50 years, were matched on risk category (BRCA1, BRCA2, familial risk), year and age of diagnosis. Of 2,308 MRISC participants, breast cancer was detected in 93 (97 breast cancers), who received MRI <2 years before breast cancer diagnosis; 33 BRCA1 mutation carriers, 18 BRCA2 mutation carriers, and 42 with familial risk. MRISC patients had smaller (87% vs. 52% <T2, p < 0.001), more often node negative (69% vs. 44%, p = 0.001) tumors and received less chemotherapy (39% vs. 77%, p < 0.001) and hormonal therapy (14% vs. 47%, p < 0.001) than controls. Median follow‐up time was 9 years (range 0–14). Breast cancer metastasized in 9% (8/93) of MRISC patients and in 23% (21/93) of controls (p = 0.009). MFS was better in MRISC patients overall (log‐rank p = 0.008, HR 0.36, 95% CI 0.16–0.80), with familial risk (log‐rank p = 0.024, HR: 0.21, 95% CI 0.04–0.95), and in BRCA1 mutation carriers (log‐rank p = 0.055, HR 0.30, 95% CI 0.08–1.13). MFS remained better in MRISC patients after lead time correction (log‐rank p = 0.020, HR 0.40, 95% CI 0.18–0.90). Overall survival was non‐significantly better in MRISC patients (log‐rank p = 0.064, HR 0.51, CI 0.24–1.06). Annual screening with MRI and mammography improves metastasis free survival in women with BRCA1 mutation or familial predisposition.