The new method enables significantly improved visibility of tumors.

Carmen Dannecker – the radiologist at Affidea brustCare – Breast Center Zurich, talks about cancer prevention and an extended form of mammography.

In addition to conventional mammography for the detection of breast cancer, contrast-enhanced mammography has recently also been introduced.

How does this new method work?

The so-called CE-MAM (contrast-enhanced mammography / KM-MG) is an extension of mammography that provides significantly improved visibility of tumors. From a size of around three millimeters, breast cancer is supplied locally by newly formed small blood vessels. These vessels differ from others in the body because they are more permeable. The contrast agent administered through a vein leaks into these areas and “lights up” on the image at the location of the tumor. This not only makes breast cancer visible, but also shows the size of the tumor and any additional tumors.

When is contrast-enhanced mammography used?

In addition to determining tumor size more precisely in breast cancer, CE-MAM can be used for further clarification of unclear findings in mammography and ultrasound. In such cases, the absence of “enhancement” can rule out a malignant tumor in almost all cases and thus helps to avoid unnecessary biopsies.

For certain tumors, chemotherapy is administered before surgery in order to shrink the tumor. To assess how the tumor responds to therapy, CE-MAM can also be used.

What are the advantages of contrast-enhanced mammography?

Because it works on a similar principle to magnetic resonance imaging (MRI), CE-MAM offers a comparable alternative for women who suffer from claustrophobia. During an MRI, patients must lie still for about twenty minutes in a prone position inside the “tube,” while loud noises occur. For many people, this is highly stressful and sometimes only possible with sedatives. CE-MAM is also an excellent alternative for women with pacemakers.

What is the actual procedure for contrast-enhanced mammography?

Many women appreciate that they are not left alone: a radiology specialist is always present in the room close to the patient. While seated, contrast agent is administered through a vein. It is the same contrast agent used in computed tomography (CT). Two minutes later, the mammography is performed. Shortly after administration, temporary sensations such as warmth, a metallic taste, or an urge to urinate may occur.

Working at the Breast Center Zurich since 2022: Carmen Dannecker, specialist in radiology with a focus on breast imaging

What happens afterwards?

The patient remains under observation for about thirty minutes due to possible – but very rare – allergic reactions to the contrast agent. Afterwards, she can be discharged. She should drink plenty of fluids throughout the day, as the contrast agent is eliminated through the kidneys. There are no restrictions afterwards.

What about radiation exposure?

Radiation exposure is slightly higher than with conventional mammography. For comparison: the natural annual radiation exposure in Switzerland is 1 millisievert (mSv). Mammography is about 0.4 mSv, while contrast-enhanced mammography (KM-MG) is around 40% higher.

Are there studies on the effectiveness of KM-MG?

In recent years, the number of publications on study results worldwide has increased significantly, and numerous studies are currently underway or planned. Until now, MRI was the only method to examine the breast using contrast agent, which is why KM-MG results are measured against MRI. Studies are promising and show comparable results to MRI.

How long does a patient have to wait for the results?

The images are assessed immediately after the examination by a radiologist and discussed directly with the patient. Waiting times are minimal. This way, the patient receives clarity faster than with other methods.

In which cases should a woman undergo breast cancer screening?

Mammography is currently the standard examination for early detection of breast cancer. Since one in eight women will face breast cancer during her lifetime, we recommend mammography every two years starting between the ages of 45 and 50. If there are breast cancer cases among close relatives, screening is usually recommended more frequently, after consultation with the gynecologist, family doctor, or following advice from a specialized breast center.

Is breast cancer screening free of charge?

Early detection programs, also known as screening programs, are organized at cantonal level. They send an invitation for a mammogram every two years to all women aged 50 and over living in the respective canton. Unfortunately, this is not the case in all cantons. Only in cantons with such a prevention program does basic health insurance cover preventive mammography.

Who pays in cantons without a screening program?

In cantons without early detection programs, basic insurance covers the cost of mammography only if a physician wants to clarify a medical finding. However, many supplementary insurance plans offer mammography for early detection.

And if breast cancer is suspected?

In that case, it is no longer about prevention. If a woman has symptoms or complaints, or if something is detected during a screening examination, all follow-up examinations – including KM-MG – are billed through health insurance.

Contrast-enhanced mammography offers many advantages. Why is Switzerland behind compared to other European countries?

In countries with widespread screening programs, such as the Netherlands, there is a high demand for fast, high-quality diagnostic options to further clarify suspicious mammography findings. The use of contrast agent is very helpful and previously was only possible with MRI. That is why these countries in particular have been actively looking for solutions that are quickly available, cost-effective, and equally reliable.

Does that mean Switzerland wants to fully utilize MRI equipment first to justify the investment before using more cost-effective examinations?

No, I wouldn’t say that. The same MRI scanner can be used not only for breast imaging but for virtually any part of the body. For breast imaging, MRI will remain the first choice for women with genetic mutations, for example.

What role will artificial intelligence play in breast cancer detection?

Artificial intelligence is currently being tested in breast imaging in several countries, including Switzerland. It is already being used in Sweden to assess screening mammograms. The potential for its use in KM-MG is also very large, and several studies are currently underway worldwide.

How do you see the future of breast cancer treatment?

Thanks to increasingly precise diagnostics, early detection, and ever-improving treatment approaches tailored to each individual patient, a breast cancer diagnosis is no longer a death sentence for most patients today. Surgical techniques allow breast-conserving operations in most cases, and oncology treatments target tumors more precisely and reduce the risk of recurrence. For patients, this means good survival chances while maintaining quality of life.

Interview by Silvia Aeschbach, Sonntagszeitung