A study conducted by researchers at the Mayo Clinic sheds light on the potential role contrast-enhanced mammography (CEM) can play as a supplemental screening tool for women at elevated risk of breast cancer.

The findings, published in the Journal of Clinical Oncology, demonstrate the promising diagnostic performance of CEM as an alternative to MR for patients with limited access or contraindications to MR.

The prospective, single-center study looked at 460 asymptomatic women aged 35 and older with an International Breast Cancer Intervention Study (IBIS) lifetime risk score of 15% or greater or a personal history of breast cancer. All participants had received negative mammography results within 180 days before enrollment. The study aimed to evaluate CEM’s ability to detect additional cancers in this high-risk population.

CEM identified 14 cancers in 11 patients, resulting in a supplemental cancer detection rate of 23.9 per 1,000 women screened. All identified cancers were either grade 1 or 2, estrogen receptor-positive, and node-negative, with tumor sizes ranging from 4 to 15 mm. These results align closely with outcomes reported for supplemental MR screening.

The study reported high specificity (87.5%) and sensitivity (91.7%) for CEM. However, the false-positive recall rate of 12% highlighted the need for careful follow-up to minimize unnecessary biopsies and anxiety among patients.

"As clinicians and radiologists gain more familiarity and experience with CEM, they can refine their ability to differentiate benign findings from those requiring further evaluation," lead author, Dr. Bhavika K. Patel, told HCB News. "With increased use, reader confidence and specificity will naturally improve, as has been observed with other advanced imaging technologies."

The findings add to a growing body of evidence supporting CEM’s role as a cost-effective, accessible option for high-risk populations. This could pave the way for broader implementation, particularly in resource-limited settings where MR availability is constrained.

“The cost and infrastructure requirements of MR have been barriers for many patients," noted Patel. "CEM provides a feasible and effective alternative for high-risk screening."

Access to CEM has barriers of its own. These include the slow adoption of new technologies and awareness gaps that prevent patients as well as clinicians from recognizing the diagnostic potential of CEM, Patel told HCB News. Other challenges to implementation are the technological considerations. CEM necessitates IV contrast, an on-site radiologist, adjustments to workflow, and slightly higher radiation doses than conventional mammography.

While the results are promising, the study emphasized the need for larger, multi-institutional trials to validate findings and evaluate the long-term impact of CEM on reducing interval cancers and breast cancer mortality.

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