Quality and Safety

Screening Contrast-Enhanced Mammography: Ongoing Prospective Trials

Location: Concourse Foyer Kiosk

First Author(s)

AK

Aneka Khilnani, MD

Resident Physician - Radiology
New York Presbyterian - Columbia Irving Medical Center
New York, New York, United States

Co-Author(s)

RL

Roberto Lo Gullo, MD

Program Director, Breast Imaging Fellowship and Assistant Professor of Radiology
Columbia University Irving Medical Center, United States
KP

Katja Pinker-Domenig, MD, PhD

Chief, Division of Breast Imaging and Professor of Radiology
Columbia University Irving Medical Center, United States
DK

Delia Keating, MD

Director, Avon Foundation Center for Breast Imaging; Associate Professor of Radiology at CUMC
Columbia University Irving Medical Center, United States
JS

Janice Sung, MD

Associate Chief, Division of Breast Imaging and Professor of Radiology at Columbia University Med
Columbia Irving Medical Center, United States

Purpose: CEM combines mammography with functional assessment of tumor vascularity and is emerging as a promising supplemental screening tool. This review summarizes ongoing and prospective screening trials of CEM, outlining current evidence and their potential clinical impact.

Methods/Materials: Active, prospective CEM screening trials were identified via clinical trial registries and published protocols. Study populations, screening intervals, comparative modalities, and primary endpoints were reviewed.

Results: Several ongoing prospective trials are evaluating CEM as a primary or supplemental screening tool for breast cancer and have reported interim results. TOCEM (US) includes three annual screenings with DBT and CEM in women with a personal history of breast cancer. Interim results show annual CEM increased CDR (7.1/1,000 in year 1; 3.8/1,000 in subsequent years) and recall rates (6.6% in year 1; 5% in years 2–3). BRAID (UK) compares supplemental CEM, abbreviated MRI, and ABUS in women aged 50–70 with dense breasts and prior negative mammograms. Interim results show CEM increased CDR compared to ABUS, at the cost of slightly increased recall rates. SCEMAM (US) evaluated screening CEM plus DBT in MRI-eligible women. Interim results demonstrated increased early-stage cancer detection (ICDR 10/1,000) and improved diagnostic performance (AUC 0.92 vs 0.73 for DBT alone) with CEM; however, it also highlighted higher false-positive recalls.

Three prospective trials are pending: CMIST (US) will compare CEM plus DBT versus DBT alone in average/intermediate-risk women with dense breasts; C-MERIT (US) will integrate CEM with risk assessment and biomarkers in women with dense breasts; and DENSE-2 (Netherlands) will evaluate CEM versus abbreviated MRI in 36,000 women aged 49–72 with dense breasts and prior negative mammograms.

Conclusions: Prospective trials are expanding evidence for CEM, primarily in women with dense breasts, elevated risk, or prior cancer. Early data suggest improved cancer detection with acceptable increased recall. Ongoing studies are critical to optimize patient selection and screening intervals, positioning CEM as a scalable adjunct or alternative to MRI in risk-adapted screening.