Contrast Enhanced Mammography–for High Risk Patients

Breast cancer is a disease that affects both men and women worldwide. In the United States, breast cancer is the most common cancer diagnosed in women, with over 281,000 new cases expected in 2021 alone (1). While screening mammography is an effective tool for early detection, it has limitations in certain patient populations, particularly those at high risk for breast cancer. Fortunately, advances in imaging technology have led to the development of contrast-enhanced mammography (CEM), a promising option for improving breast cancer detection in high-risk patients.

CEM is a type of mammography that uses a contrast agent, usually iodine-based, to highlight areas of abnormal blood flow in the breast. Unlike traditional mammography, which uses X-rays to create a two-dimensional image, CEM produces three-dimensional images that provide more detailed information about breast tissue (2). This increased level of detail can be especially useful for detecting small or early-stage tumors, which may not be visible on a standard mammogram.

High-risk patients, such as those with a strong family history of breast cancer or a genetic mutation that increases their risk, may benefit from CEM. A study published in the Journal of Clinical Oncology found that CEM detected significantly more cancers than traditional mammography in women with a BRCA1 or BRCA2 mutation, who have a lifetime risk of breast cancer that is 5-10 times higher than that of the general population (3). Another study published in the Journal of Magnetic Resonance Imaging found that CEM was more sensitive than MRI in detecting cancer in women with a history of breast cancer or other high-risk factors (4).

In addition to improving cancer detection, CEM may also reduce the number of false-positive results and unnecessary biopsies. A false-positive result occurs when a mammogram suggests the presence of cancer, but further testing reveals that no cancer is actually present. False positives can cause anxiety and lead to additional testing, including biopsies, which carry their own risks and complications. A study published in the American Journal of Roentgenology found that CEM had a lower rate of false-positive results than traditional mammography, which could reduce the number of unnecessary biopsies (5).

Despite its potential benefits, CEM is not yet widely available. The technology is still relatively new, and many radiology practices have not yet adopted it. Additionally, CEM may be more expensive than traditional mammography or other imaging modalities, which could limit its accessibility for some patients.  For women in the South Bay Area, Dr. Patel offers this service at Breast Imaging Specialists in Los Gatos, CA

In conclusion, contrast-enhanced mammography is a promising option for improving breast cancer detection in high-risk patients. It has been shown to be more sensitive than traditional mammography and may reduce the number of false-positive results and unnecessary biopsies. While the technology is still relatively new and not yet widely available, it represents an important advance in breast cancer screening that could save lives.


  1. American Cancer Society. (2021). Breast Cancer Facts & Figures 2021-2022. Retrieved from
  2. Leithner, D., Wengert, G. J., Helbich, T. H., & Thakur, S. (2018). Contrast-enhanced mammography: Technique, results, indications, and future directions. European Journal of Radiology, 102, 151-160.
  3. Sung, J. S., Li, J., Da Costa, G., & Mammography Surveillance in BRCA Mutation Carriers (MAMMOTH) Study Group. (2016). Cost-effectiveness of screening

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