Contrast-enhanced mammography (CEM) has shown promise for women at higher risk of breast cancer, with follow-up screening showing greater specificity and accuracy.

Cancer detection rates remained consistent during repeat screening, while specificity improved compared with baseline examinations.

Specificity shows how accurately a test identifies people who do not have the disease, helping to reduce unnecessary follow-up procedures.

Researchers at Memorial Sloan Kettering Cancer Center analysed 6,911 contrast-enhanced mammography screens carried out among 2,756 women between 2015 and 2021.

Contrast-enhanced mammography, or CEM, combines standard mammography with an injected contrast agent that highlights areas of increased blood flow. Cancerous tumours often develop a greater blood supply.

The team compared 1,575 baseline screens with 3,336 incidence screens.

The researchers classified a screen as baseline if the woman had no previous CEM or had not undergone breast MRI in the previous three years.

Incidence screens were follow-up examinations carried out after previous screening.

After adjusting for the number of screens each woman received, the researchers found no statistically significant difference in cancer detection rates between the groups.

However, specificity reached 91.5 per cent during incidence screening, compared with 83.4 per cent for baseline screening.

Overall accuracy was also higher for incidence screening, at 91.4 per cent compared with 83.5 per cent.

“The ability of contrast-enhanced mammography to help detect cancer during prevalence screening in women at increased risk for breast cancer is maintained in subsequent incidence screens, with better specificity and accuracy,” the research team wrote.

Baseline screening detected 19 cancers per 1,000 examinations, compared with 11.6 per 1,000 incidence screens.

Sensitivity, which measures how well a test identifies people who have a disease, was 87.1 per cent for baseline screening and 86.1 per cent for incidence screening.

Contrast enhancement alone helped detect 18 of the 30 cancers found during baseline screening and 36 of the 62 found during incidence screening.

The researchers also identified 14 interval cancers across the examinations, with no evidence of a difference between the two groups.

An interval cancer is diagnosed after a screening result appears normal but before the next scheduled examination.

The retrospective study used previously collected clinical records rather than following participants in a newly designed trial.

The researchers described CEM as a reasonable screening tool for women with dense breasts.

Dense breasts contain more fibrous and glandular tissue, which can make cancer more difficult to detect with standard mammography.

CEM has previously shown greater sensitivity than ultrasound, digital mammography and digital breast tomosynthesis, according to the article.

Digital breast tomosynthesis takes several low-dose X-ray images from different angles to create a three-dimensional view of breast tissue.

The technique also takes less time and generally costs less than breast MRI, with previous research suggesting its performance is not inferior to MRI.

CEM is currently used for some screening purposes outside its approved indications.

The researchers said it could also help address health inequalities affecting women who face barriers to accessing MRI.

“In addition, women have reported a preference for CEM over MRI,” they wrote.

The researchers said a future article would provide full details about the interval cancers identified in the study.

An accompanying editorial said the technique could become a practical part of breast cancer screening for selected groups, although challenges remain around wider adoption.

“Whether this potential ultimately translates into widespread implementation will depend on future studies evaluating not only diagnostic performance, but also patient outcomes, health care utilisation, and real-world feasibility across diverse practice settings,” wrote Dr Vivianne Aguilera Freitas of the University of Toronto.

AstraZeneca’s breast cancer drug Etcamah has been approved in the EU as part of a combination treatment for advanced disease.

The European Commission acted on a positive opinion from the Committee for Medicinal Products for Human Use, the Cambridge, England-based drug maker said.

The decision followed positive results from the Serena-6 phase III trial, which showed a 56 per cent reduction in the risk of disease progression in advanced oestrogen receptor-positive breast cancer.

A phase III trial is a large, late-stage study used to assess a treatment’s safety and effectiveness before wider regulatory approval.

Oestrogen receptor-positive breast cancer is a form of the disease that can grow in response to the hormone oestrogen.

Etcamah, whose generic name is camizestrant, was tested in combination with a cyclin-dependent kinase 4/6 inhibitor.

Known as CDK4/6 inhibitors, these medicines block proteins that help cancer cells grow and divide.

AstraZeneca said the Etcamah combination has also been approved in Japan, the UAE and Saudi Arabia based on the Serena-6 trial results.

The company said breast cancer remains the leading cause of cancer death among women in Europe, with more than 140,000 deaths and more than 540,000 patients diagnosed in 2024.

AstraZeneca shares were down 0.6 per cent at 12,628 pence in London on Thursday.

Women newly diagnosed with breast cancer have a 59 per cent higher risk of ischaemic stroke in the first year after diagnosis, research suggests.

Researchers also said survivors who develop sudden stroke symptoms, including one-sided weakness, facial drooping, speech difficulties or vision loss, should seek immediate medical attention.

The multicentre study analysed National Health Insurance Service data from 107,606 women who underwent surgery for newly diagnosed breast cancer and compared them with 322,818 age-matched women with no history of cancer.

The research was conducted by professor Shin Dong-wook of Samsung Medical Center, professor Han Kyung-do of Soongsil University, professor Yong-Moon Mark Park of the University of Arkansas for Medical Sciences and professor Wonyoung Jung of the University of Pennsylvania.

Professor Yong-Moon Mark Park said: “The study demonstrates a time-dependent pattern in which the risk of ischaemic stroke rises sharply immediately after breast cancer diagnosis and treatment before gradually declining.

“The key finding is that we evaluated stroke risk according to different stages following diagnosis and treatment. This suggests that clinicians should consider not only how much the risk increases, but also when it is greatest.”

The study included women aged 18 or older who were newly diagnosed with breast cancer between 2010 and 2016, underwent surgery and had no previous stroke.

Each patient was matched with three women of the same birth year who did not have cancer. Participants were followed for an average of 7.2 years.

The main outcome was ischaemic stroke, also known as cerebral infarction. It occurs when a blocked blood vessel cuts off blood flow to the brain and is a leading cause of death and long-term disability.

During follow-up, ischaemic stroke occurred in 1,155 breast cancer patients, or 1.07 per cent, and 3,698 women in the control group, or 1.15 per cent.

Overall, breast cancer surgery was not linked to a significantly higher long-term risk of ischaemic stroke, and researchers recorded a slight fall in risk over time.

However, a different pattern emerged immediately after diagnosis.

Within one year of diagnosis, patients had a 59 per cent higher risk of ischaemic stroke than women without cancer.

The risk was highest during the first three months, at 2.90 times that of the control group.

It remained elevated within six months, at 2.27 times the control group’s risk, before gradually declining.

The risk was still 17 per cent higher three years after diagnosis.

Researchers said the temporary increase may be linked to cancer-related hypercoagulability, inflammatory responses to surgery and treatment, and cardiovascular stress caused by anticancer therapies.

Hypercoagulability means the blood is more likely than usual to form clots. Cardiovascular refers to the heart and blood vessels.

The increased risk was particularly pronounced among patients with hypertension, type 2 diabetes or a history of current smoking.

Hypertension means high blood pressure. Type 2 diabetes is a long-term condition affecting how the body controls blood sugar.

Breast cancer patients who smoked had a 2.26-fold higher risk of ischaemic stroke than comparable women without cancer.

Principal researcher professor Shin Dong-wook stressed the importance of vigilant care for patients with cardiovascular risk factors, especially during the early phase of breast cancer treatment.

Shin said: “Patients with hypertension, diabetes, or other cardiovascular risk factors, as well as those who smoke, require particularly careful management during the early phase of breast cancer treatment.

“If patients who have undergone breast cancer treatment suddenly develop weakness in one arm or leg, facial drooping, slurred or abnormal speech, or vision loss on one side, ischaemic stroke should be suspected, and they should seek immediate medical evaluation.”

Researchers said survivorship care should include strategies to monitor and manage cardiovascular and cerebrovascular disease risk throughout treatment as advances in breast cancer care continue to improve survival.

Cerebrovascular disease refers to conditions affecting blood flow and blood vessels in the brain.