Purpose: Contrast-enhanced mammography (CEM) is being studied as an alternative to screening MRI in women with a history of breast cancer. Our purpose was to evaluate patient experiences with CEM to determine whether it would be accepted by patients for screening.
Materials and Methods: This was a prospective survey of women with a history of breast cancer who had CEM instead of their annual mammogram from July 2020 to August 2021. The survey included questions regarding prior contrast imaging and their current CEM experience. Preferences were determined using a 5-point Likert Scale. Participants provided verbal responses to a research coordinator within one month of their CEM. An interpreter was used for non-English speaking patients. Fisher’s exact test was used for analysis.
Results: 115 women were surveyed with a 77% (88/115) response rate. 10% of patients were non-English speaking. 13% had both CEM and breast MRI exams previously,14% had prior CEM only, 40% had prior MRI only, and 34% had no prior contrast-enhanced imaging.
90% had no complaints about CEM. 91% indicated that CEM was the right length for annual imaging. 94% were comfortable with contrast as part of annual breast imaging and 93% would accept the risk of a contrast reaction. There was no significant association with prior contrast imaging. 96% wanted CEM for their next annual exam.
No major adverse events occurred. Reported side-effects included warmth in the pelvis (81%), urge to urinate (66%), warmth in other areas (58%), lightheadedness (16%), dizziness (11%) and metallic taste (9%).
25% preferred CEM to mammography, 14% preferred mammography, and 61% were neutral. Of those who had prior MRI and responded to the question (n=44), 50% preferred CEM to MRI, 7% preferred MRI, 43% were neutral (Fig.1). There was no significant association with prior CEM or MRI exposure (p=0.6).
Conclusion: Women with a history of breast cancer indicated CEM is acceptable for annual imaging in terms of exam length, contrast administration, and overall experience. CEM was preferred over both MRI and mammography. Prior history of CEM or breast MRI did not impact patient preferences.
Clinical Relevance Statement: A majority of women with a history of breast cancer had no complaints regarding CEM as an annual exam and a large percentage preferred it to breast MRI. Our data suggests CEM would be well-received as an MRI and mammogram alternative for breast cancer screening.
