Evaluating ten years of breast cancer screening with contrast enhanced mammography in women with Intermediate-high risk.

Purpose: While mammography is considered the gold standard for screening women for breast cancer, its accuracy declines in women with dense breasts. The purpose of the study is to evaluate the diagnostic accuracy of contrast enhanced mammography (CEM) for detecting breast cancer in intermediate and high-risk women, including those with genetic predispositions, over a decade-long cohort at a tertiary center.

Methods: We retrospectively analyzed all CEM examinations performed for screening purposes at a tertiary center between 2012 and 2023. Data were extracted from imaging reports and from medical records. All biopsies performed up to one year following CEM examinations, and all breast cancer cases were extracted. BI-RADS scores from CEM reports were compared to biopsy results and to imaging follow-up. Sensitivity, specificity, positive and negative predictive values, area under the ROC curve (AUC), and cumulative cancer detection rate were calculated.

Results: Overall 5,424 screening CEM examinations were analyzed. The mean age was 54.8 ± 8.9 years. Family history of breast cancer was recorded in 1,134/5,424 (20.9 %) women. Most women (4,606/5,424, 84.9 %) had dense breasts (BI-RADS C-D). Overall, 628 biopsies were performed within one year of screening, and 74 cancers were detected. CEM had sensitivity 95.9 % (71/74), specificity 81.8 % (4378/5350), positive predictive value 6.8 % (71/1043), negative predictive value 99.9 % (4378/4381). The cancer detection rate for CEM was 13.1 per 1,000 cases, and the AUC was 0.923.

Conclusions: CEM is a viable breast cancer screening method for women with dense breasts. Future prospective studies are needed to evaluate the long-term prognostic impact of CEM screening.