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CONTRAST ENHANCED MAMMOGRAPHY (CEM)


Screening CEM
Diagnostic CEM

As a screening tool for high-risk women

If you are considered to be at high risk for breast cancer (greater than 20% lifetime risk), you may be eligible for additional screening tests. In the past, many doctors have recommended annual breast MRI screening for their high-risk patients. While breast MRI offers very high accuracy, the cost—as high as $2,000 or more—may be prohibitively expensive especially if it is not covered by your insurance provider.

Rose Imaging Specialists offers contrast-enhanced mammography (CEM), a highly accurate and more patient-friendly screening option for high risk women. It offers comparable sensitivity to breast MRI in detecting cancer, but with fewer false positives than breast MRI. The exam time is shorter (15 minutes versus about an hour with MRI), costs much less than MRI and there is less difficulty obtaining insurance pre-authorization.

For women who get anxious or claustrophobic in an MRI scanner, CEM offers a less confining alternative. It is also an option for women who are obese or have implanted metal devices that would prohibit them from undergoing a breast MRI.

Before your screening CEM

If you are still having menstrual periods, you may schedule a screening CEM anytime of the month.  However, if your breasts are usually tender during your period, you may want to have your mammogram or procedure performed within two weeks after your menstrual period ends.

In addition, please remember:

Do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. The residue left on your skin by these substances may interfere with interpretation of the mammogram.

If possible, obtain prior mammograms and make them available to the radiologist at the time of the current exam.

For your safety, please notify our scheduling department and technologists if you believe you may be pregnant or if you have breast implants.

CEM requires the injection of an iodine-based contrast agent, a safer and better-tolerated alternative than gadolinium for most patients, prior to the exam. If you are allergic to iodine, please inform us immediately.

During Your Screening CEM

Our technologists are dedicated to breast imaging and take special care to make the experience as comfortable as possible. You will need to remove any jewelry that might interfere with the X-ray picture. You will need to remove your clothes above the waist, and you will be given a robe for the test.

One at a time, your breasts will be positioned on a flat plate that will acquire the image while a paddle compresses your breast tissue.  Firm compression is needed to spread out the tissue and obtain a high-quality image. You will be instructed to hold your breath during the exam for just a few seconds of compression.  You may be asked to lift your arm or use your hand to hold your other breast out of the way.

The entire exam takes only 15 minutes.

As a diagnostic test

Contrast given intravenously prior to digital mammography enables detection of cancers not visible on a conventional mammogram. This makes CEM a valuable tool for diagnostic examinations which has been shown to shorten the time between diagnosis and treatment for women with breast cancer, as well as lower their overall cost of treatment.

The timely detection and treatment of breast cancer is vital to optimizing survival and minimizing recurrence. However, for women with an abnormal screening mammogram, the median time from the exam to follow-up care is approximately two weeks,1 and the time between diagnosis and surgery is approximately one month.2

Reasons for the delay are generally attributed to the time required to schedule, pre-authorize and perform follow-up testing, such as diagnostic mammography, ultrasound, stereotactic or image-guided biopsy and preoperative breast MRI.

Breast MRI has become a preferred modality to determine the extent of disease and for preoperative planning, as its use has shown to reduce the incidence of reoperation, recurrence, and mortality. However, breast MRI is associated with a delay in treatment of up to three weeks.3 In addition, use of MRI has been shown to double the unadjusted median cost of testing within the diagnostic/ preoperative window.4

Through the use of contrast-enhanced mammography, the radiologists of Rose Imaging Specialists have been able to significantly shorten the time between detection and treatment, as well as lower the overall cost of care.

REFERENCES

  1. Karen J. Wernli, PhD et al. Timing of follow-up after abnormal Screening and Diagnostic Mammograms Am J Manag Care. 2011 Feb; 17(2): 162–167.
  2. Amanda R. Kupstas M.D., et al. Effect of Surgery Type on Time to Adjuvant Chemotherapy and Impact of Delay on Breast Cancer Survival: A National Cancer Database Analysis Annals of Surgical Oncology volume 26, pages 3240–3249(2019)
  3. Bleicher RJ, Ciocca RM, Egleston BL, et al. Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. Journal of the American College of Surgeons. 2009;209(2):180–187. quiz 294-185.
  4. Tracy Onega, et al. Costs of diagnostic and preoperative workup with and without breast MRI in older women with a breast cancer diagnosis BMC Health Serv Res. 2016 Feb 27; 16: 76.

Before your Diagnostic CEM

A diagnostic CEM uses the same equipment as a screening mammogram.  It differs from a screening mammogram in that additional views of the breast are taken, so it takes slightly longer.

If you are still having menstrual periods, you may schedule a diagnostic CEM anytime of the month.  However, if your breasts are usually tender during your period, you may want to have your CEM performed within two weeks after your menstrual period ends.

In addition, please remember:

Do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. The residue left on your skin by these substances may interfere with interpretation of the mammogram.

If possible, obtain prior mammograms and make them available to the radiologist at the time of the current exam.

For your safety, please notify our scheduling department and technologists if you believe you may be pregnant or if you have breast implants.

CEM requires the injection of an iodine-based contrast agent, a safer and better-tolerated alternative than gadolinium for most patients, prior to the exam. If you are allergic to iodine, please inform us immediately.

During Your Diagnostic CEM

Our technologists are dedicated to breast imaging and take special care to make the experience as comfortable as possible. You will need to remove any jewelry that might interfere with the X-ray picture. You will need to remove your clothes above the waist, and you will be given a robe for the test.

One at a time, your breasts will be positioned on a flat plate that will acquire the image while a paddle compresses your breast tissue.  Firm compression is needed to spread out the tissue and obtain a high-quality image. You will be instructed to hold your breath during the exam for just a few seconds of compression.  You may be asked to lift your arm or use your hand to hold your other breast out of the way. Several pictures are taken of each breast, one from the top and one from the side.

The entire exam takes approximately 30 minutes