Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Journal of breast imaging
Contrast-Enhanced Mammography for Breast Cancer Screening: A Systematic Review and Meta-Analysis
OBJECTIVE: To evaluate pathway-specific cancer detection and summarise screening outcomes (recall/biopsy/PPV3) for contrast-enhanced mammography when reported, and to compare them with those for low-energy mammography and breast MRI. METHODS: This systematic review and meta-analysis followed PRISMA guidelines. PubMed (MEDLINE), Embase, Scopus, and Web of Science were searched from January 1, 2011, through August 31, 2025, for studies evaluating contrast-enhanced mammography in screening or surveillance populations (including supplemental/add-on screening and surveillance of patients with a personal history of breast cancer). Diagnostic, recall, and problem-solving studies were excluded. Screening pathways were categorized as: (1) direct comparison with low-energy mammography, (2) direct comparison with MRI, and (3) add-on CEM to mammography-based screening. Random-effects meta-analyses were performed when designs were comparable. Comparisons between CEM and MRI were summarized qualitatively because of heterogeneity and limited cancer events across studies. Single-arm screening studies were summarized descriptively. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). RESULTS: Fourteen studies met eligibility criteria for qualitative synthesis; seven screening and surveillance studies contributed to the meta-analysis. Compared with low-energy mammography, CEM detected 9.3 additional cancers per 1,000 women screened (risk difference [RD], +9.3 per 1,000; 95% CI, 4.0-14.6; P < 0.01; I2 = 0%). Three studies directly compared CEM with MRI in screening settings and were summarized qualitatively because of heterogeneity and limited cancer events. CONCLUSION: In screening and surveillance populations, contrast-enhanced mammography increases cancer detection compared with low-energy mammography. Evidence from available comparative studies suggests that cancer detection with CEM may be broadly comparable to MRI in selected screening contexts; however, the limited number of studies and heterogeneous designs preclude definitive comparative conclusions. These pathway-specific estimates may inform clinical implementation and the design of prospective screening trials.
30 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Patients' expectations and barriers towards postoperative telehealth follow-up after oncologic breast surgery in France
BACKGROUND: Surgery is the most frequent treatment for breast cancer and requires postoperative follow-up to detect complications and monitor patient recovery. Postoperative telemonitoring has demonstrated benefits in improving rehabilitation and psychological well-being. However, patient expectations of and barriers to telehealth follow-up after oncologic breast surgery remain insufficiently explored. METHODS: A prospective survey was conducted among adult patients attending pre- or postoperative follow-up appointments for breast cancer in the Department of Breast and Reconstructive Surgery at the Civil Hospitals of Colmar between March and August 2025. The questionnaire comprised four sections: demographic data, treatments received, telemedicine accessibility and acceptability, and patient expectations of and barriers to telemonitoring. RESULTS: A total of 124 questionnaires were analyzed. Results demonstrated high accessibility to digital tools among participants. Although patients recognized several advantages of telemonitoring, most expressed a strong preference for in-person follow-up visits. The most expected features included the ability to report postoperative complications and to monitor recovery and pain. The main barrier was the fear of reduced human contact. Retired status was associated with lower acceptance of postoperative telemonitoring. CONCLUSION: These findings support the implementation of a hybrid follow-up model combining early postoperative telemonitoring with later in-person consultations, which could help reassure patients and shorten hospital stays while maintaining personalized care. The monocentric design may limit the external validity of the findings. Future studies should explore patients' perceptions following repeated use of telemonitoring tools and incorporate healthcare professionals' perspectives on their integration into clinical practice.
7 July 2026
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