Learning About Contrast-Enhanced Mammography

Contrast-enhanced mammography (CEM) is a test to find breast cancer. It takes X-ray pictures of the breast, like a regular mammogram. It also uses contrast material.

Contrast material, or contrast dye, is a substance that makes blood vessels or types of tissue (such as tumors) more visible on X-rays. For CEM, this dye is given through an intravenous (I.V.) tube.

There are different types of contrast dyes. The type used for CEM is iodine.

CEM can find areas of abnormal breast tissue and new blood vessels. Both of these are signs of breast cancer.

CEM is better at finding breast cancer than a regular mammogram. It finds most breast cancers about as well as an MRI. But it’s not yet used for routine breast cancer screening.

You may have a CEM if:

• A regular mammogram found abnormal breast tissue.
• You have symptoms of breast cancer, like a lump.
• You have a high risk for breast cancer. You may have a high risk if you've had breast cancer or have a family history of breast cancer.
• You have dense breast tissue.

A doctor may use CEM to help plan surgery for newly diagnosed breast cancer. CEM can also show how well chemotherapy is working to shrink a tumor before surgery for breast cancer. CEM is sometimes used for people who can’t have an MRI.

• You will need to take off any jewelry that might interfere with the X-ray pictures.
• You will need to take off your clothes above the waist and change into a cloth or paper gown.
• Contrast dye will be put into your arm or hand through an I.V. tube.
• About 2 minutes later, X-ray pictures will be taken with a regular mammogram machine.
• You will probably stand during the mammogram.
• One at a time, your breasts will be placed on a flat plate.
• Another plate is then pressed firmly against your breast to help flatten out the breast tissue. You may be asked to lift your arm.
• For a few seconds while the X-ray picture is being taken, you will need to hold your breath.
• At least two X-rays will be taken while the breast is flattened.
• A computer will put the X-rays together to make one image that only shows the contrast dye. This will help your doctor see any problems more clearly.
• About four images may be made of each breast.

When the contrast dye is given through the I.V., you may feel a quick sting or pinch. The dye may make you feel warm and flushed and give you a metallic taste in your mouth. Some people feel sick to their stomach or get a headache. Tell the technician or your doctor how you are feeling.

The mammogram may also be uncomfortable, and for some people it can be painful. But having your breasts flattened helps the technician get the best images. The discomfort is brief. Let your technician know if you need a break.

Mammograms expose you to a very small amount of radiation. With CEM, the radiation dose is slightly higher than it is for a regular mammogram. For most people, the benefits of CEM outweigh the low risk from radiation.

There is a slight chance of an allergic reaction from the contrast dye used during the test. But most reactions are mild and can be treated using medicine. People with poor kidney function or an allergy to iodine-based contrast dye should not have CEM.

If you breastfeed and are concerned about whether the contrast dye used in this test is safe, talk to your doctor first.