Contrast-enhanced mammography improves patient access to functional breast imaging

Imaging research pathways focus increasingly on the development of individualised approaches to breast cancer detection, diagnosis and management. Detection of breast cancer with X-ray mammography may fail in some cancer subtypes with limited changes in morphology/tissue density and in women with dense breasts. International organisations offer recommendations for contrast-enhanced breast imaging, as it provides superior sensitivity for screening, local staging and assessment of neoadjuvant treatment response, when compared with standard X-ray mammography (including tomosynthesis) and breast ultrasound. Arguably, the evidence base is stronger for contrast-enhanced MRI (CE-MRI). Unfortunately, patient access to breast MRI in rural and remote areas is limited by practical limitations and equipment licensing restrictions. Moreover, breast MRI is an expensive test, likely to be out of reach for many women. Contrast-enhanced mammography (CEM) offers an attractive alternative to improve patient access to functional breast imaging. It is a new type of digital, dual energy X-ray mammography that can be performed on most modern units, following a relatively inexpensive hard- and software upgrade. In this paper, we review the rapidly accumulating evidence that CEM can provide similar diagnostic accuracy to CE-MRI, though at a significantly lower cost and offering greater comfort to the patient. The adoption of CEM can help meet the anticipated increased demand for CE-MRI.