There's a relatively new test that is being described by many as a game changer in the world of mammography.
For lots of women and people with dense breasts, this different examination means their scan results are far clearer compared with a standard mammogram — meaning any abnormalities can be picked up easier. And that has the capacity to save lives.
So it's seriously great news for boobs.
First and foremost, what is contrast-enhanced mammography?
Among medical professionals, it's well known that mammography has its limitations.
On a standard X-ray mammogram, the normal breast tissue comes up on the scan as white — and so too can evidence of cancer. With this in mind, it can be possible for breast cancer to be missed or not detected earlier.
This is where contrast-enhanced mammography, or CEM, comes in.
Watch: how to check our breasts. Post continues below.
CEM refers to imaging that is performed after an injection of a contrast agent. A rapid series of images are taken like a normal mammogram, but it's the quality of the pictures that makes for an impressive result — the contrast is helping to highlight areas of possible abnormality.
As a patient, what can you expect when you get a contrast-enhanced mammogram?
Dr Mary Rickard is a world-recognised breast imaging radiologist with broad-ranging expertise in imaging techniques and training. Working at Sydney Breast Clinic, Dr Rickard said that from a patient's perspective, a CEM appointment is super similar to having a standard mammogram.
"The only real difference is that there is a needle involved. You have a small intravenous cannula put into your arm wherever there's a good vein. We inject a bit of saline into the cannula like any procedure just to test that it's working well. Then the contract agent is injected, similar to some CT scans," Dr Rickard explained to Mamamia.
"It takes about two minutes for the contrast agent to go through the bloodstream, and then we immediately start the routine mammogram. Only this time, we get one picture that looks like a normal mammogram and one picture that shows us the contrast agent in comparison to the breast tissue."
For anyone who has had a contrast test before, you would know it is normal to feel like you need to urinate a little bit, while the contrast agent goes into your body.
But don't fear — you won't actually pee yourself. Overall, it only lasts one minute and is a pretty funny feeling, but not a painful one.
Dr Rickard said that in terms of receiving the results, it takes a very similar amount of time as a standard mammogram would (around a week), which is fabulous.
So what does the research tell us about contrast-enhanced mammography's accuracy?
The answer is good things, my friends.
"You get a far more accurate diagnosis. It's far more sensitive, and that means it finds more cancers if they are present. With mammography alone, the likelihood of being able to diagnose cancer (depending on the density of the breast) is somewhere between 50 to 80 per cent. With CEM — it's around 95 per cent," Dr Rickard said to Mamamia.
Ultimately, there's nothing more worthwhile than being able to detect abnormalities as early as possible.
Comparative studies have shown that CEM diagnostic accuracy is equal to that of breast MRI, which is pretty extraordinary.
"The option of MRI is often far more expensive, and people who are paying a gap on MRI would be paying $1,000 plus. So contrast-enhanced mammography often works out cheaper. CEM is also more widely available than MRI machines — because any modern mammography machine can have CEM software added on," Dr Rickard said.
"Plus MRIs often have a very long waitlist. And many find the MRI tunnel quite claustrophobic and noisy. So compared to a half-hour MRI, a CEM examination is 10 minutes."
Okay, let's talk about the cost.
"At the moment in Australia, there is a Medicare reimbursement for having a mammogram. Different practices will charge a different amount of the mammogram — generally resulting in a gap cost on top of the Medicare cost," Dr Rickard explained.
"There's not an extra Medicare reimbursement for the contrast agent. So most places offering CEM will charge an additional fee for the contrast agent and that's usually non-rebatable."
So if the Australian Government happens to be reading this — maybe a Medicare reimbursement for CEM appointments would mean even more women across Australia would have access to this game-changing technology.
The fee for the contrast agent changes from practice to practice across the country. But generally speaking, it can cost from $250 to $500 extra, Dr Rickard estimated.
For a good portion of women in Australia, they get their mammograms reimbursed through their state's or territory's Breast Screen service.
But not everyone has access to this, meaning many do pay out of pocket for various reasons.
As Dr Rickard noted, opting for CEM can work out to be cheaper for some people — particularly those with dense breasts who usually require both a mammogram and then an MRI or ultrasound. Because if they opted for just CEM, many would no longer need to do the MRI/ultrasound on top of the mammogram if the test is only deemed 'inconclusive'.
As for accessibility?
This one's a bit blurry.
Breast Screen only provides plain mammography according to Dr Rickard.
For those wanting a CEM examination, it is "not offered outside of the private sector". So in regional and rural areas, the fight likely continues for greater access to healthcare of all kinds — including mammography.
So who exactly would benefit from opting for contrast-enhanced mammography?
A LOT of people.
Those with dense breasts, a high breast cancer risk, or anyone who is keen for a more accurate test are the big winners. There are some who will find that CEM isn't for them after consulting with their doctor, one example being those who have heart disease.
But another group that could find CEM to be a big benefit is those with health or medical-related anxiety.
For Mia Freedman, she has referred to herself as someone who is medically anxious. And after trying contrast-enhanced mammography recently, she said the more accurate result made her feel extra reassured. Plus, the shorter appointment meant she could be in and out without leaving too much time for overthinking.
Faster sessions, clearer results and reduced need for re-testing is, without a doubt, a massive win.
Why don't more women know about contrast-enhanced mammography?
Speaking anecdotally around the Mamamia office, and with one another's wider family and friends circles, there were very few who actually knew about CEM.
"It's not widely promoted, but it is a terrific test. I've only recently been involved in conferences and meetings looking at whether CEM technology could be the answer to improving mammography screening," Dr Rickard said.
So what's the end takeaway from this deep dive?
CEM is simple, quick and extremely accurate. And in some cases, it can help avoid other additional tests if a standard mammogram is simply inconclusive for density reasons.
So if you have dense breasts or think this type of test would benefit you — ask your doctor. Because it's a worthwhile conversation. Both for your boobs and peace of mind.
Feature Image: Supplied.
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