Contrast-Enhanced Mammography (CEM) for Breast Cancer Screening

Four Methods for Breast Cancer Screening

1. Self-Breast Examination: Recommended for women of all ages, this should be done monthly. Women who are menstruating should perform the exam 7-10 days after their period ends, as breasts are softer and less tender.
2. Breast Examination by Healthcare Providers: For women aged 20 and above, screening every three years is advised, and annually for women over 40.
3. Breast Ultrasound: Suitable for women under 25, those with dense breast tissue, pregnant women, or breastfeeding mothers, as it can distinguish between normal tissue, lumps, and cysts.
4. Digital Mammography: Recommended annually for women aged 35 and older to detect masses or calcifications that may indicate early-stage cancer. After 40, screening every 1-2 years is suggested. In cases of high risk, mammography may be combined with ultrasound or other diagnostic techniques, such as Contrast-Enhanced Mammography (CEM), which offers clearer insights when cancer suspicion or higher risk is present.

What is Contrast-Enhanced Mammography (CEM)?

Contrast-Enhanced Mammography (CEM) is a breast imaging technique that combines digital mammography with an iodine-based contrast agent, approved by the FDA in the United States since 2011 and widely used internationally.

During CEM, a radiology technician will take low-energy X-rays to capture breast structure and detect general abnormalities, along with high-energy X-rays to show contrast-agent absorption areas, which highlight any abnormalities like tumors or cancer cells. This imaging includes views from both the craniocaudal (top-down) and mediolateral oblique (angled) perspectives, covering breast tissue comprehensively. If needed, compression may be applied to specific areas based on findings.

Images from four angles for each breast are processed to clearly and accurately locate abnormal tissue or lumps, differentiating cancerous from normal vascular patterns.

Preparing for CEM and Screening Process

Preparation:

• Disclose health history, especially kidney, thyroid, asthma, or allergy issues, and any previous reactions to contrast agents.
• Avoid applying lotion, powder, perfume, or deodorant, as these can cause ‘antiperspirant artifacts’ on X-rays that may resemble calcium deposits on the skin or breast tissue
• It’s best to avoid scheduling during menstruation to minimize discomfort from breast tenderness.

Screening Process:

• A small IV will be inserted in the arm or wrist for the contrast agent injection.
• After a two-minute circulation period, during which some may feel warm or slightly nauseous, the radiology technician will use a dual-energy technique to capture images from each breast. The entire procedure takes about eight minutes.

Benefits of CEM and Who is Suitable For the Test

CEM is highly effective and is particularly useful for:

• High-risk individuals: Those with BRCA1 or BRCA2 mutations or direct family history of breast cancer.
• Dense breast tissue: CEM improves detection of small abnormalities, reducing unnecessary biopsies.
• Suspicious symptoms or abnormal results: Provides precise imaging for better diagnostic clarity.
• MRI limitations: For those unable to undergo MRI, CEM offers similar accuracy at a lower cost.
• Surgical planning and treatment monitoring: Helps map tumor extent and evaluate response to therapies.

Limitations and Precautions

• Possible Side Effects: Allergic reactions, such as skin rash or eye irritation, may occur but are rare.
• Special Considerations for Certain Conditions: Diabetics, hypertensive patients, and those with kidney issues should ensure their conditions are stable before the exam. Kidney function tests may be required.
• Pregnancy and Breastfeeding: For nursing mothers, feeding can resume 12-24 hours after the exam.
• Not Recommended for Breast Implants with Silicone: Additional techniques may be needed for accurate results.

Early breast cancer screening is invaluable, and women are encouraged to request female practitioners if it provides added comfort. For guidance on the most suitable screening options, the Phyathai 2 Hospital Breast Center offers comprehensive breast cancer screening programs tailored to individual needs.