What is Contrast Enhanced Mammography?

Women with dense breasts, or those who have a higher-than-average risk of breast cancer, can now choose to have a contrast enhanced mammogram when they come for their annual breast cancer screening at Columbia University Irving Medical Center (CUIMC) and NewYork-Presbyterian (NYP) in northern Manhattan.

The test, which uses an iodine-based dye in conjunction with a regular mammogram, has been shown to find up to four times as many cancers as a regular screening mammogram. It also finds them earlier, when tumors are smaller and easier to treat.

“It’s challenging to detect cancer on a mammogram for women with dense breasts,” says Janice Sung, MD, associate chief of the Division of Breast Imaging at CUIMC. This is because dense breast tissue appears white on a mammogram, sometimes obscuring tumors which also appear white on the image. “These women are often scheduled for additional testing, such as a breast ultrasound or breast MRI.”

And while breast magnetic resonance imaging (MRI) is a very effective and important test, contrast-enhanced mammography offers another advanced option that is easier to access for many women. “With contrast enhanced mammography, we’re able to offer this powerful, vascular-based imaging to far more women,” says Sung.

Contrast enhanced mammography was FDA approved for diagnostic mammograms in 2011. Women who were called back for additional testing after an inconclusive screening mammogram—often due to dense breasts—could then receive the contrast enhanced exam. Sung has been researching its use as a screening tool for more than a decade. “As we gained more experience in the diagnostic setting, we realized that it would benefit the greatest number of people if we use it as a screening tool,” she says.

Sung and division chief Katja Pinker-Domenig, MD, PhD, who both joined Columbia’s Department of Radiology in 2024, have already successfully launched a contrast enhanced mammography screening program at Memorial Sloan Kettering Cancer Center, where they previously worked. They are now launching a pilot program at the Herbert Irving Pavilion breast imaging center in Washington Heights, which they plan to expand across Columbia and NewYork-Presbyterian’s outpatient radiology sites in Manhattan and Westchester County.  

Women who know they have dense breasts from previous screening mammograms, or who regularly get an ultrasound with their annual mammogram, can ask for the contrast enhanced exam when they make an appointment.

“The beauty of a contrast enhanced mammogram is that it replaces your regular annual mammogram,” says Sung, reducing women’s chances of being called back for additional testing. The contrast is administered through a vein (intravenously) right before the exam, which then proceeds like a regular mammogram. On the resulting images, immature blood vessels that form early around tumors are highlighted, making even tiny cancers visible on the images.

High-risk women who already get screened with breast MRI should continue to schedule MRIs, says Sung. Contrast enhanced mammography is also not recommended for women with a known allergy to iodinated contrast, pregnant women or women with kidney disease.

Annual screening mammograms find an average of five cancers per 1000 women; when started at age 40, screening with mammography has been shown to decrease deaths from breast cancer by approximately 30 percent. Studies have shown that adding contrast to the exam leads to the detection of an additional 7 to 24 cancers per 1000 women. Not all area of concern will be cancers, Sung says, but the research has shown that the benefits outweigh the risks. “Many of the things that we're finding turn out to be cancer,” she explains, “but there will be false positives, and that's something that patients should be aware of.”

Contrast enhanced mammography is not widely available for regular screening mammograms in New York City. “That number is going to is going up,” says Sung. “Our goal is to offer it to far more women, because there is such a benefit.”