Dense Breasts? You Need to Ask Your Doctor for This Type of Mammogram

Yahoo

11 hours ago

For millions of women, the words 'you have dense breasts' can feel both vague and unsettling—especially when it comes after a routine mammogram. Breast density isn't just a technical term buried in a radiology report, it's a real risk factor that can make it harder to spot cancer early. Yet many women aren't told what that means for their health or what steps they can take next. One powerful, underused tool? Contrast-enhanced mammography, or CEM.
Experts say it could be a game-changer for women with dense breasts, but only if they know to ask for it.
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Despite growing awareness, many women still don't know what breast density means for their screening options. In most cases, they're simply advised to return in a year for another mammogram. But experts say that for women with dense breasts, especially those with additional risk factors, there's a powerful tool that could offer earlier, more accurate detection: contrast-enhanced mammography, or CEM.
CEM is a relatively new imaging technique that combines the familiar process of a mammogram with an iodine-based contrast dye, similar to what's used in a CT scan. This allows radiologists to see blood flow to areas of the breast—highlighting suspicious areas that might otherwise be hidden by dense tissue. Studies show it can detect more cancers than standard mammography or even 3D mammograms, especially in dense breasts.
So why isn't every woman with dense breasts getting one?
Experts say it's partly due to lack of awareness—both among patients and healthcare providers—as well as uneven access and insurance coverage. But as more states pass laws requiring women to be notified about their breast density, and as clinical data continues to support CEM's accuracy, the message is becoming clearer: if you have dense breasts, asking your doctor about CEM could be a lifesaving conversation.
Contrast-enhanced mammography is much simpler than it sounds. By injecting an iodine-based dye into the vein in combination with a traditional 2D or 3D mammogram, radiologists can have a better view of abnormalities that are more difficult to see on a regular mammogram. The dye serves as a contrast (hence the name) against healthy breast tissue, allowing your provider to more easily view any lesions and determine if they are benign or cancerous.
'Our breasts are made up of glands, connective tissue and fatty tissue,' Dr. Meleen Chuang, chief of obstetrics and gynecology at NYU Langone Hospital Brooklyn, told Flow Space. 'The density of breast is a term used to describe the amount of different types of breast tissue seen on a mammogram. Dense breast tissue has higher amounts of glandular tissue and connective tissue and low amount of fatty tissue.'
Dense breasts are common, and almost half of women who are over 40 that get mammograms are found to have dense breast tissue. Doctors use the Breast Imaging Reporting and Data System (BI-RADS) to classify breast density. This system, developed by the American College of Radiology, helps doctors interpret and report back mammogram findings.
'Dense breasts are a risk factor for breast cancer compared to women with fatty breasts,' said Chuang. 'This risk is separate from the effect of dense breasts on the ability for the radiologist to read a mammogram.'
There is not yet enough evidence to recommend for or against additional imaging tests, such as ultrasound or MRI to screen for breast cancer in women with dense breasts according to the Recommendation Statement on Breast Cancer Screening by the United States Preventive Services Task Force (USPSTF).
'However, for many women with dense breasts, the radiologist may often recommend spot compression images to redo a mammogram in certain areas after the screening mammogram and would often then review those areas with breast sonogram,' said Chuang.
For those with dense breasts, supplemental imaging might be a requirement in your screening plan given your increased risk of breast cancer.
What does it mean to have dense breasts? Having dense breasts increases a person's risk of developing breast cancer, and it can also make it more challenging for radiologists to detect cancer on a traditional mammogram. Nearly 50% of women have dense breasts, making it a common breast cancer risk factor.
So, what are the most common types of screenings:
Ultrasound: Breast ultrasound uses sound waves and their echoes to make computer pictures of the inside of the breast. It can be helpful to show certain breast developments that may be difficult to see on a mammogram, such as differentiating benign fluid-filled cysts from potentially cancerous solid masses. Ultrasound can be used for additional imaging if the patient has dense breasts.
MRI: Breast MRI (which stands for magnetic resonance imaging) uses radio waves and strong magnets to make detailed pictures of the inside of the breast. It is typically used to screen high-risk patients or diagnose areas difficult to see under mammography. Like CEM, breast MRIs require a contrast dye to be injected into your vein before the pictures are taken. MRIs historically detect more cancers compared to traditional mammograms and ultrasound, so they're typically recommended for patients with dense breasts or other breast cancer risk factors.
CEM: Contrast-enhanced mammography exams are conducted using the same mammography equipment as a traditional mammogram, but they also use contrast dye. Just like ultrasound and MRI, they can be used for additional imaging for patients with dense breast tissue.
3D Mammogram: A 3D mammogram, also known as digital breast tomosynthesis, is an advanced form of breast imaging that creates a three-dimensional picture of the breast using multiple X-ray images taken from different angles. Unlike traditional 2D mammograms, which produce a flat image, a 3D mammogram allows radiologists to examine breast tissue layer by layer, making it easier to detect small tumors that might be hidden by overlapping tissue. This technology is especially helpful for women with dense breasts, where distinguishing between normal and abnormal tissue can be more difficult. While 3D mammography has improved cancer detection rates and reduced false positives, it can still miss cancers that a contrast-based test like CEM might catch.
Previous studies have shown that CEM offers a comparable diagnostic performance to contrast breast MRI. Most recently, a study was published that found that CEM is able to detect three times as many cancers in dense breast tissue compared to ultrasound, as well as smaller tumors compared to traditional mammograms. CEM has been gaining wider acceptance in recent years as a possible alternative to MRI, since it is a more comfortable and familiar experience compared to MRI and offers comparable detection rates.
Not to mention, patients have reported that they significantly prefer CEM compared to breast MRI due to increased comfort, lower noise levels, decreased feelings of anxiety and greater procedure efficiency. CEM is also more cost effective compared to MRI (typically around 25% of the cost), and CEM patients receive their results within 8-10 minutes compared to 45 minutes with MRI.
While standard and 3D mammograms rely solely on differences in tissue density to detect abnormalities, CEM uses an iodine-based contrast dye to illuminate areas where tumors may be growing and drawing blood. This functional imaging approach can reveal cancers that are otherwise hidden in dense breast tissue, which appears white on mammograms—the same color as many tumors.
Studies have shown that CEM can detect more cancers than 2D or 3D mammograms alone and has accuracy comparable to breast MRI, which is considered the gold standard for high-risk screening. But unlike MRI, CEM is quicker, more widely available and less expensive. For women who need more sensitive screening but can't access or tolerate an MRI, CEM offers a powerful, accessible alternative that could catch cancer earlier—when it's most treatable.
CEM provides a very appealing offer for those who need to get supplemental imaging but have concerns about detection performance with ultrasound or cost or claustrophobia with MRI.