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What is Contrast-Enhanced Mammography?

Contrast-Enhanced Mammography (CEM) is a type of breast imaging that uses:

  • A standard mammogram, and
  • An iodine-based contrast injection given before the scan

The contrast helps show areas with increased blood supply, which can sometimes make suspicious changes easier to see.

CEM may be used:

  • When further assessment is needed after other breast imaging
  • For selected patients where additional information is needed
  • In some cases as an alternative to breast MRI, depending on clinical circumstances
ABC 3d mammography and 3D Tomosynthesis

What are the benefits of Contrast‑Enhanced Mammography (CEM)?

  • Improved cancer detection in dense breasts: CEM overcomes many of the limitations of density by focusing on vascular changes rather than tissue appearance
  • Helps differentiate surgical change from cancerous change: CEM is an excellent addition for screening after breast cancer surgery as it distinguishes post-surgical scars from tumour recurrence
  • Comparable to MRI: It offers a similar cancer detection rate to breast MRI but is quicker, more comfortable, and generally more accessible
  • Fast turnaround: Results are often available the same day

CEM may not be appropriate for people with:

  • Known allergies to iodine or contrast dye
  • Have breast implants. (We can image the
    other breast in cases with one implant)
  • Significant kidney disease
  • Pregnant

Who is Contrast‑Enhanced Mammography (CEM) suitable for?

  • For the first 5 years after the diagnosis of
    breast cancer
  • For patients where MRI is recommended but they are unable to have one
  • Elevated risk:
    º There is a genetic mutation
    º Lifetime risk of breast cancer is above 20-25%
    º History of chest radiation before the age of 30
    º Strong family history
  • Recommended after complex mammography
    and/or ultrasound findings

CEM is not appropriate for everyone. Your radiologist or referring doctor will decide whether it is the right for your situation.
Auckland Breast Centre mature lady smiling

What happens during the appointment?

  • A mammographer will ask you safety questions and request your consent to go ahead with the examination
  • A small cannula will be placed into a vein, preferably in your elbow crease
  • In the mammography room, you will receive the contrast injection. You may feel a warm sensation or metallic taste in the mouth – this is normal and usually passes off quickly
  • Two minutes after the injection is complete, the mammography exam will start. The images, positions and compression are all the same as a routine mammogram. The mammographers will guide you through the positions
  • You will need to wait for 20 minutes after the injection and then the cannula can be removed
  • A radiologist will review your images and discuss these with you whenever possible before you leave. A detailed medical report will be sent to your GP or surgical team
FAQs

Yes, you can eat and drink as normal before your appointment, fasting is not required.

We recommend staying well hydrated by drinking 2–3 glasses of water 1 hour prior to your appointment. You may also use the bathroom as usual before and after the procedure.

Please do not apply deodorant, body oils, creams or lotions to the breast and under arm area on the day of your appointment. 

If needed, you will be able to apply deodorant after your scan.

We recommend wearing comfortable clothing that separates at the waist, such as a skirt or pants with a top.

You will be asked to remove your clothing from the waist up, an you will given a gown to wear during your appointment.

The contrast agent used in Contrast-Enhanced Mammography is well tolerated by most patients. Some people may experience a brief warm sensation, a mild metallic taste, or slight flushing following the injection, these effects are temporary and usually pass quickly.

Serious reactions are rare, and you will be carefully screened beforehand to ensure the contrast is safe for you.

Contrast-Enhanced Mammography (CEM) is performed in an open room using a standard mammography machine. There are no enclosed spaces, making it a suitable option for patients who experience claustrophobia.

Insurance coverage for Contrast-Enhanced Mammography (CEM) is increasing. In some cases, the procedure may be billed as a diagnostic mammogram.

We recommend checking with your insurance provider to confirm your level of cover.