When Your Doctor Needs a Better View

You know mammography. Ultrasound. MRI. But have you heard of contrast-enhanced spectral mammography (CESM)? It’s a new type of mammogram that can provide a more accurate assessment of your breasts, particularly if you have dense breasts. In fact, one of the main reasons your doctor may want to perform a CESM is because you have dense breasts, which affects about half of all women who undergo breast screening, 10 percent of whom have extremely dense breasts.1

This makes it quite challenging to identify abnormalities on mammography because it is difficult to tell the difference between the fibrous tissue in the breast and the tumor tissue, especially with very early cancers.2 You might also need a CESM to evaluate abnormalities identified on screening mammography or ultrasound, or to pinpoint the location of a suspected cancer and evaluate the extent of the disease.3

Contrast-enhanced spectral mammography is a quick exam that can provide a much better image than mammography or ultrasound alone. Thus, your doctor can rule out cancer right away rather than calling you back for another look. In fact, CESM improves breast cancer detection in dense breasts up to 20 percent better compared to regular mammography.4

It works just like a normal mammogram except it requires an injection of iodine into your bloodstream. The iodine collects in blood vessels that could be feeding abnormal cells, such as cancer cells, lighting them up like a Christmas tree. The procedure is quite safe. The only side effect is a reaction to the contrast solution, which affects less than 1 percent of women.3

Until CESM became available, women with dense breasts or suspicious findings typically underwent an MRI. However, MRI is expensive. In addition, people with pacemakers, certain aneurysm clips or other metallic hardware, or those who are claustrophobic or who can’t lie still on their back can’t undergo an MRI. In fact, between 1 and 15 percent of people having an MRI need sedation to undergo the procedure, or have to stop in the scan before it finishes. 5

Another drawback to MRI is that it can take days or even weeks to schedule and it has to be scheduled at a certain time in your menstrual cycle. Yet CESM can be performed immediately after a suspicious mammogram – no waiting.6

One other advantage is that while a breast MRI can take up to an hour to perform, a CESM may take just seven minutes.5 Plus, you can have the test the same room as your mammogram, using the same machine. This may help reduce your stress and anxiety. In fact, studies find that patients prefer the CESM experience to breast MRI, saying it is faster and provides greater comfort, less noise, and reduced anxiety.5,7

So, if your doctor recommends a CESM, remember: It’s just like a mammogram only with an injection of iodine and it will get you both the answers you need quickly.



  1. Kerlikowske K, Zhu W, Hubbard RA, et al. Outcomes of screening mammography by frequency, breast density, and postmenopausal hormone therapy. JAMA Intern Med. 2013;173(9):807-816.
  2. Travieso Aja MM, Rodriguez Rodriguez M, Alayon Hernandez S, et al. Dual-energy contrast-enhanced mammography. Radiologia (Roma). 2014;56(5):390-399.
  3. Phillips J, Mehta TS. Setting Up a CESM Program. In: Lobbes M JM, ed. Contrast-Enhanced Mammography: Springer; 2019.
  4. Data on File. GE Healthcare. 2017.
  5. Patel BK, Gray RJ, Pockaj BA. Potential Cost Savings of Contrast-Enhanced Digital Mammography. AJR Am J Roentgenol. 2017;208(6):W231-w237.
  6. Mann RM, Kuhl CK, Kinkel K, et al. Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol. 2008;18(7):1307-1318.
  7. Phillips J, Miller MM, Mehta TS, et al. Contrast-enhanced spectral mammography (CESM) versus MRI in the high-risk screening setting: patient preferences and attitudes. Clin Imaging. 2017;42:193-197.

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