Contrast-enhanced mammography: One more tool for breast cancer detection

Patients who can’t receive magnetic resonance imaging (MRI) have a new alternative through contrast-enhanced mammography (CEM). This diagnostic tool combines a standard mammogram with contrast to get a better picture of the breast tissue and identify areas of concern early. CEM is available at Atlantic Health Overlook Medical Center.

Howard Szikman, DO, a breast imaging specialist at Atlantic Health, shares more about this innovative tool and how it is supporting patients throughout New Jersey.

More breast cancer screening options for high-risk patients

MRI is an important diagnostic tool for detecting breast cancer. For high-risk patients, MRI is a more sensitive test than standard mammograms or ultrasounds. Unfortunately, many patients — whether because of pregnancy, metal implants, claustrophobia or other concerns — can’t get MRIs.

“An estimated 12%, or 1 in 8, women will be diagnosed with breast cancer in their lifetime,” says Dr. Szikman. “Some women are at higher risk than others, and we want to have more screening options available to support them. When we screen for breast cancer routinely, we can find more cancers at an earlier stage when they may be easier to treat.”

When MRI is not an option, CEM is an ideal tool for some people, including:

• Those with a high risk of developing breast cancer
• Patients with known cancer to determine the extent of the disease
• Women who need a biopsy quickly

If a patient had a finding on a breast MRI that needs a biopsy, radiologists may use CEM as a faster and more comfortable alternative to guide the biopsy. And when MRI is not covered by insurance or too expensive, CEM may be a more cost-effective alternative to breast MRI.

“CEM is less expensive and can help us reach a broader population, ensuring that underserved patients have access to a higher sensitivity exam,” says Dr. Szikman. “It helps us provide better services to more people.”

How does CEM work?

CEM is performed much like a standard mammogram, except patients are first injected with iodinated contrast — the same contrast used for CT scans. Unlike an MRI, patients’ breasts are compressed, so radiologists can get clear images of the tissue. The mammography team uses instruments to make the process less uncomfortable. The procedure takes less than 20 minutes.

CEM images highlight areas with increased blood flow, often making cancer more visible, especially in women with dense breast tissue. Among 1,000 patients, 3D mammograms find 2.5–3 suspicious tissues, highly sensitive MRIs detect 16–20 and CEM detects around 9–10.

“Because MRI is so sensitive, it can catch things that are not cancer, leading to anxiety and delays,” says Dr. Szikman. “CEM is more specific and filtered to the more suspicious things, which helps avoid unnecessary biopsies and other procedures.”

Bringing CEM to patients in New Jersey

Overlook Medical Center is one of the few locations in New Jersey to offer CEM. Dr. Szikman is part of a group of experts bringing this technology to Atlantic Health. The team includes specialists with years of experience as radiologists and fellowships in breast imaging. These radiologists and the technologists supporting them have completed additional CEM training.

“We want to continue to bring innovations to Atlantic Health and our community, especially something that isn’t offered routinely or available at most places, like CEM,” says Dr. Szikman. “We want to be on board when new diagnostic and treatment options become available to better serve our patients and community.”