Contrast Enhanced Mammography

What is contrast enhanced mammography (CEM)?

Contrast enhanced mammography (CEM) is an advanced type of mammogram that combines traditional mammography with an intravenous (IV) contrast agent to help detect breast cancers that may not be visible on a standard mammogram. At Columbia Radiology, CEM is available as a screening option for women who are at higher-than-average risk for breast cancer or who have dense breast tissue.

Is contrast enhanced mammography (CEM) used for screening?

Yes, at Columbia Radiology, contrast enhanced mammography is offered at some locations for annual screening mammograms, for eligible women. 

CEM is also widely used as a diagnostic test, to follow up on an abnormal screening mammogram or new breast symptom.

Why choose contrast enhanced mammography (CEM) for screening?

Studies show that mammograms with contrast detect approximately 12 additional cancers that would be missed on a regular screening mammograms, making CEM especially effective for higher-risk women or women with dense breasts. It also finds tumors earlier, when they are smaller and easier to treat.

Dense breast tissue can make cancers harder to see on a standard mammogram because both dense tissue and cancer appear white on the images. CEM highlights new blood vessels that develop when cancers grow, helping radiologists identify cancers that might otherwise be hidden.

Who should consider a contrast enhanced mammogram for screening?

You may benefit from screening CEM if you:

• have dense breasts
• routinely undergo supplemental screening with ultrasound
• have an increased lifetime risk of breast cancer
• have a family history of breast cancer
• are not already being screened with breast MRI

How do I get a contrast enhanced mammogram?

Your healthcare provider can indicate contrast enhanced mammography when they order your annual screening or diagnostic mammogram at Columbia. You can then call our scheduling team to schedule your exam. Be sure to schedule in advance because there are fewer appointments for contrast mammograms than for regular screening mammograms. ¥ou may also be responsible for an out-of-pocket cost for a screening contrast enhanced mammogram.

How do I get ready for a contrast enhanced mammogram?

• If you have had any breast imaging done outside of Columbia, Cornell, or NewYork-Presbyterian, be sure to provide us with those images before your appointment. These will be loaded into our system so the radiologist can compare. This is extremely important as a change from prior images can be a sign of breast cancer.
• On the day of your exam, do not wear any deodorant, body powder, or lotion on your breasts or underarm areas.
• Be prepared to undress from the waist up and put on a gown.

What will happen during a contrast enhanced mammogram?

• When you arrive for your appointment, you will be asked to undress from the waist up and change into a gown.
• A nurse will place an intravenous line (IV) in your arm.
• You will be given the iodinated contrast dye through the IV. Many patients feel a warm sensation as they are getting the IV contrast dye.
• You will stand facing the mammography machine. The mammography technologist will position your breast carefully between two rectangular plates. These plates compress the breast between them to flatten and spread the tissue to get the best quality exam. The pressure lasts only a few seconds while the image is taken. This will feel similar to any mammogram you have had in the past
• The technologist will instruct you to hold your breath and remain still for a few seconds. Motion, even breathing, can blur the image and make it necessary to repeat the picture.
• The technologist will take two pictures, one from the side and one from the top of the breast.
• The technologist will repeat the procedure to image both breasts.

Are there any risks to contrast enhanced mammography (CEM)?

There are very few risks associated with getting a contrast enhanced mammogram. People who have had any allergic reaction to iodinated contrast dye in the past or who have kidney disease should not have contrast enhanced mammography. Contrast enhanced mammography is also not recommended for women who are pregnant or breastfeeding. Risks include:

• Radiation: People who have contrast enhanced mammograms may be exposed to slightly more radiation than people who have regular mammograms.
• Allergic reaction: Most reactions to intravenous contrast dye are mild, such as hives. Some people can have more serious reactions, such as having trouble breathing or swelling of the face.
• Intravenous iodinated contrast can affect kidney function, although the risk of acute kidney injury is very low in people with normal kidney function. If you have factors that may increase your risk of kidney problems (kidney disease, diabetes, high blood pressure requiring medication, or protein in your urine), a blood test to assess kidney function will be performed before your CEM.

What will happen after a contrast enhanced mammogram?

• The nurse will remove the IV line and place a small bandage over the site.
• Drink six to eight eight-ounce glasses of water in the 24 hours after the exam to help remove the contrast dye from your body.
• You can resume your normal activities immediately after the exam.

Will my insurance cover a contrast enhanced mammogram?

When contrast enhanced mammography is used as a diagnostic mammogram, it is covered by insurance.

When contrast enhanced mammography is used as an annual screening mammogram, there may be an additional cost for the patient. Ask about costs when you call to schedule your exam.

Medically reviewed by Janice Sung, MD
Last updated 8/20/2026