There are several reasons why you may be referred for CEM. You may have dense breasts or known risk factors such as a family history of breast cancer.  Your doctor may be investigating an unusual symptom such as a breast lump or monitoring you following treatment for breast cancer. CEM can also be used for planning purposes prior to breast cancer surgery.

The required patient preparation is similar to conventional mammography/tomosynthesis. 

If you have breast implants you might need a longer appointment time, so please let us know when you make your appointment.

You are advised not to wear talcum powder, lotion, or deodorant on the day of the examination, as these substances can appear on the images. You should wear a two-piece outfit, as you will be asked to undress from the waist up. 

It is very important to bring any previous mammograms with you so a comparison with your current examination can be made.

CEM requires an intravenous injection of iodine-based contrast agent or dye. All patients will be required to complete a consent form to determine whether they are suitable for contrast.  If you have previously had any reaction to any type of contrast agent or dye, you should alert staff at the time of booking.  If you have known kidney disease, diabetes or taking Metformin, you will be asked to have a blood test prior to your appointment to test your kidney function. 

We also recommend that you fast from solid food for 3 hours prior to your examination but remain well hydrated.  This means you should drink plenty of water on the day of (and after) your CEM. 

The mammographer or nurse will use a needle to insert a cannula (a small plastic tube) into a vein in your arm or the back of your hand so the iodine contrast can be injected into the cannula just before the mammograms are performed.

When the iodinated contrast is injected, most people will get a strange metallic taste in the mouth and feel a warm sensation through the body. This warm sensation may concentrate around the groin or buttock region and can feel like you may have wet yourself, even though you have not. Do not be concerned if this happens, it is a common sensation and usually goes away within a couple of minutes.

Shortly after the contrast injection, the mammographer will take the images.  For the best quality images, the four mammograms (2 images of each breast) will be performed within 6 minutes.

The CEM appointment is approx. 15mins longer than conventional mammography.  This is primarily because of the insertion of the cannula for the contrast administration part of the examination. 

All patients are asked to remain in the clinic for 15 to 30 minutes following the conclusion of their examination – just so staff can monitor for any post-injection reactions. 

Radiation
Like all conventional mammogram CEM exposes you to some radiation. There is slightly more radiation with CEM, about the same as having an extra mammogram picture taken. 

Such a small risk is far outweighed by the benefit of early detection of breast cancer, significantly reducing the death rate from the disease. The Health Protection Agency of the United Kingdom estimates the risk of an additional cancer in a lifetime from a single mammographic examination to be in the low-risk range: 1 in 100,000 to 1 in 10,0003. The risk of developing cancer from a mammogram is no greater than developing cancer from exposure to the natural background radiation accumulated from the normal environment in one year. 

Breast Implants
If you have breast implants, there is an extremely small risk of damage to the implant.  You will be given additional information and a consent form regarding your breast implants.

IV contrast
Occasionally patients feel nauseous for a short time during and after the injection. Occasionally there is leakage of contrast agent outside the blood vessel (which is treated with ice and compression). 

If you already have severe kidney disease or diabetes or both, kidney function in these cases may temporarily worsen, but in most cases returns to normal.  Minor reactions (1 per 100 people) can present with prolonged vomiting, a generalised rash, or swelling of the face, mouth or throat and often need treating with drugs. Severe reactions – including death – occur in fewer than 1 in 100,000 people.  These people require emergency medical treatment and often admission to hospital.  Your clinic is equipped to treat all reactions immediately. 

Early detection of breast cancer can dramatically affect treatment options and survival rates.

CEM increases the breast cancer detection rate, provides more information about the extent of newly diagnosed breast cancers, allows effective evaluation of breast cancer for treatment planning, is lower in cost than breast MRI and more appropriate for patients with claustrophobia.  CEM can also decrease the number of unnecessary recalls for further imaging and possibly biopsy, therefore reducing unnecessary anxiety.

It is best to check with the individual clinic to ask if they offer CEM, as it is not widely available.

Queensland

I-MED Radiology St Andrews Level 1, 457 Wickham Tce, Brisbane: T 07 3831 4333 F 07 3831 4355

I-MED Radiology Chermside Chermside Medical Complex Suite 6, 956 Gympie Rd, Chermside: T 07 3326 4700 F 07 3359 6871

Victoria

I-MED Radiology Monash 212 Clayton Road (cnr Dixon St next to MMC), Clayton: T 03 8540 3400 F 03 8540 3444

Your doctor will receive a written report on your test as soon as is practicable.  It is very important that you discuss the results with the doctor who referred you so that they can explain what the results mean for you. 

CEM is not advised for women who are pregnant.  While breastfeeding a CEM may be performed, if necessary, after discussion with your doctor. 

If the imaging request meets the Medicare requirement for diagnostic mammogram eligibility, patients will receive a Medicare rebate. Please note that there is an out-of-pocket cost associated with the administration of contrast which will be quoted at the time of booking.