The Utility of Contrast Enhanced Mammography as Supplementary screening modality for Breast Cancer

Background:Contrast-enhanced mammography (CEM) combines anatomical and functional imaging by demonstrating neovascularity. Multiple studies have demonstrated that supplemental CEM substantially increases cancer detection compared with mammography alone,with reported incremental cancer detection rates generally around 8–20 additional cancers per 1,000 women screened,approaching the performance of breast MRI in some studies while maintaining acceptable recall rates.
Advantages over ultrasound:Compared with screening ultrasound, CEM offers several potential advantages: Higher specificity,Better assessment of lesion extent,Fewer operator-dependent limitations,Bilateral whole-breast evaluation in a single examination,Short examination time.

Unlike ultrasound, CEM evaluates tumor vascularity rather than morphology alone.
Advantages over MRI:CEM is often viewed as a practical alternative rather than a replacement for MRI.
Potential advantages include: Lower cost,Greater availability,Faster workflow,Better patient tolerance,
Fewer contraindications related to claustrophobia or implanted devices
MRI still has the highest sensitivity for supplemental screening and remains the preferred examination when available.
Limitations:CEM also has important limitations:
Requires intravenous iodinated contrast
Small risk of allergic reaction and contrast extravasation
Slightly higher radiation dose than standard mammography (still within accepted limits)
Not suitable for patients with severe renal impairment or iodinated contrast allergy
Long-term screening outcomes,including interval cancer reduction and mortality benefit,remain under investigation.
Current guideline position:There has been a shift in recommendations over the past few years:
The 2024 American College of Radiology considers CEM an appropriate option in women at intermediate risk or who cannot undergo MRI.
The 2026 Canadian Society of Breast Imaging recommends supplemental screening for women with ACR C or D breast density, preferring MRI but recommending CEM as the next-best vascular imaging option when MRI is not feasible.
Conclusion:Multiple studies have demonstrated that supplemental CEM substantially increases cancer detection, approaching the performance of breast MRI in some studies while maintaining acceptable recall rates. Much of this evidence comes from single-center prospective cohorts,and large randomized screening trials are still ongoing.