Nearly all breast cancer survivors would recommend contrast-enhanced mammography

Hannah Murphy | October 19, 2026 | Radiology Business | Womens Imaging

Despite anxiety pertaining to the exam, many breast cancer survivors report high confidence in contrast-enhanced mammography (CEM) and would recommend it to other survivors as part of their post-treatment surveillance plan.

Survey findings published in Insights Into Imaging are offering new insight into how patients feel about having to complete CEM exams for monitoring purposes after cancer treatment. In recent years, the exam has emerged as a promising alternative to digital mammography, which has limited sensitivity in post-op patients.

“CEM has demonstrated diagnostic performance comparable to that of breast magnetic resonance imaging in various clinical contexts, including preoperative staging and supplemental screening, with increased cancer detection in post-surgical surveillance,” corresponding author Giulia Vatteroni, with the department of radiology at IRCCS Humanitas Research Hospital in Milan, Italy, and colleagues noted. “Despite its diagnostic advantages, CEM differs from DM in ways that may affect patient experience. Specifically, it requires intravenous contrast medium administration and involves slightly longer examination times and higher radiation exposure, which may influence patient tolerability and acceptance.”

Experts sought to get a better understanding of how women regard CEM as part of their surveillance regimen. To do this, they queried paitents who were part of the COMBO trial, which included women who underwent CEM instead of DM for routine surveillance between January 2023 and February 2025. Of 969 eligible women, 936 completed an anonymous questionnaire immediately after their examination. Participants had a mean age of 58.2 years.

According to the responses, most women found their experience with CEM comparable to their previous DM exams. A total of 67.4% reported similar levels of discomfort, while 77.4% reported comparable pain. Positioning was considered similar by 76.6% of participants, while 64.3% rated the exam duration as comparable.

Over 96.2% of the women reported satisfaction with CEM, and nearly all participants (99.6%) said they would recommend it to others.

Despite those feelings, anxiety was also commonly cited before imaging, with nearly half of participants (46.3%) reporting moderate-to-high pre-exam anxiety. This was attributed to the respondents’ greater perceived discomfort and pain, more uncomfortable positioning, longer perceived exam duration, less reassurance before the exam and lower comfort during contrast administration.

The group suggested that anxiety may shape how patients experience CEM, even when their overall acceptance of it is high. They added that providing clear information about the procedure, addressing concerns about contrast administration and offering reassurance may help improve the experience for women undergoing surveillance after breast cancer treatment.

“This underscores the pivotal role of the radiologist in the pre-examination phase, not only in communicating technical information, but in building trust and addressing anxiety,” the authors noted. “When women are adequately informed, the perceived diagnostic value of CEM outweighs concerns about discomfort or invasiveness.”