Patient acceptance and experience with contrast-enhanced mammography in women with a personal history of breast cancer: findings from the COMBO trial

OBJECTIVES: To evaluate patient acceptance, tolerability and experience with contrast-enhanced mammography (CEM) in women with a personal history of breast cancer undergoing routine post-surgical surveillance. MATERIALS AND METHODS: This prospective cohort study, conducted within the COMBO Trial, included consecutive women with a personal history of breast cancer undergoing CEM instead of digital mammography (DM) for routine surveillance from January 2023 to February 2025. Immediately after the examination, participants completed an anonymous 16-question questionnaire assessing discomfort, pain, exam duration, pre-examination reassurance, information received, anxiety, contrast injection, satisfaction and comparative experience with prior DM. Responses used Likert-type scales. Descriptive and non-parametric analyses were performed (p < 0.05 statistically significant). RESULTS: Of 969 eligible women, 936 (mean age 58.2 years, SD ± 10.2 years) completed the questionnaire. CEM was perceived as comparable to prior DM in terms of discomfort (631/936; 67.4%), pain (725/936; 77.4%), positioning (717/936; 76.6%) and duration (601/936; 64.3%). Overall satisfaction was high (900/936; 96.2%), and 932/936 (99.6%) of participants would recommend CEM. Although 433/936 (46.3%) of women reported moderate-to-high pre-examination anxiety, higher anxiety was significantly associated with greater perceived discomfort, pain, uncomfortable positioning, longer examination duration, lower reassurance, lower comfort during contrast medium administration, and lower overall satisfaction (all p < 0.001). CONCLUSIONS: In this large cohort of breast cancer survivors, CEM demonstrated high acceptance, satisfaction and tolerability in post-surgical follow-up. Although pre-examination anxiety negatively influenced examination experience, it did not reduce patients' willingness to undergo CEM, supporting its integration into personalised post-treatment breast cancer surveillance. KEY POINTS: Question Evidence on patient acceptance and tolerability of CEM for routine post-surgical surveillance in women with previous breast cancer is limited. Findings In 936 breast cancer survivors, CEM showed high satisfaction and tolerability, while pre-examination anxiety was associated with a less favourable experience. Critical Relevance Statement High patient acceptance supports CEM as a feasible surveillance option after breast cancer treatment, while the association between anxiety and poorer experience highlights the radiologist's role in pre-examination communication and reassurance.