Contrast-Enhanced Mammogram (CEM)

What Is a Contrast-Enhanced Mammogram (CEM)?

A contrast-enhanced mammogram (CEM) is an advanced imaging tool that is performed the same way as a standard mammogram, with one additional step — you also receive a small amount of contrast dye through an IV placed in your arm before your exam. The contrast helps highlight areas of increased blood flow within the breast tissue, allowing the radiologist to see more detail than a standard mammogram. This added information can help detect breast cancer that may be harder to see in conventional mammography. Most people tolerate the contrast well.

Who May Be a Candidate for CEM?

Your doctor may recommend CEM if you:

• Have an increased risk of breast cancer (personal history, family history, or genetic predisposition)
• Have dense breast tissue, making standard mammograms harder to interpret
• Have inconclusive results from a screening mammogram
• Have a new lump(s) identified during a physical exam
• Have contraindications to breast MRI
• Have been recently diagnosed with breast cancer
• Are undergoing treatment for breast cancer

CEMs are also helpful for women who have been diagnosed with breast cancer. The contrast dye provides additional viewing access to any areas already identified as cancerous and can help assess the effectiveness of breast cancer treatment already in progress.

What Are the Benefits of a CEM?

• Improved detection in dense breast tissue: Dense breast tissue can make it more difficult to see cancers on a standard mammogram because both dense tissue and cancer appear white on the images. The contrast dye used during CEM highlights areas with increased blood flow, helping radiologists identify abnormalities that may not be visible on a conventional mammogram.
• Alternative to breast MRI: For some women, CEM can be a comparable alternative to breast MRI. It may be a good option for those who are claustrophobic, have certain medical devices that prevent MRI, or are unable to tolerate an MRI for other reasons. CEM is also typically quicker than breast MRI, with images taken within minutes after the contrast is given. In many cases, it may also be less expensive.

Contrast-Enhanced Mammography (CEM) is a fast and efficient exam, with images acquired just minutes after the contrast agent is administered. In many cases, CEM may also be a more cost-effective option than other advanced breast imaging exams, particularly for patients with high-deductible health plans. Patients are encouraged to check with their insurance provider to understand their specific coverage and out-of-pocket costs.

3D Screening Mammogram (Tomo) vs.
CEM: What Are the Differences in These Two Exams?

3D screening mammograms and CEMs are both used to identify breast abnormalities and diagnose cancer as early as possible. Both exams compress the breasts and take multiple X-ray images of breast tissue.

There are two main differences between these two tests. First, the contrast dye produces images that highlight abnormalities more distinctly and may allow your doctor to view the breast tissue better to make a diagnosis. Second, the CEM may last longer than the 3D mammogram because of the extra time involved in administering the contrast dye.

What are the Risks Associated with CEM?

CEM is considered a safe exam for most people, However, because it uses an IV contrast dye, there are a few potential risks.

• The contrast dye is removed from your body through your kidneys. If you have severe kidney disease or significantly reduced kidney function, your healthcare provider may recommend a different imaging test or check your kidney function before the exam.
• Some people may experience a mild allergic reaction to the contrast dye, such as itching or hives. Serious allergic reactions, including difficulty breathing or a significant drop in blood pressure, are very rare. Your care team is trained to recognize and treat these reactions should they occur.

Is there a Chance of Abnormal Findings on a CEM?

There is a chance of having an abnormal CEM. This could require further testing with mammograms, ultrasound, MRI, or breast biopsy.

Contact ELizabeth Wende Breast Care to learn more.