Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with potential applications in screening, diagnosis, and procedural guidance. This review summarizes recent literature, including retrospective studies, prospective clinical trials, and meta-analyses published from 2020 to 2023, to provide an updated overview of the current state-of-the-art in CEM. CEM provides 8 standard images, including low-energy and post-contrast recombined views, which can improve visualization of cancers in dense breasts. While CEM exposes individuals to ionizing radiation and requires intravenous contrast administration, recent studies suggest that its diagnostic performance is superior to other mammographic techniques. CEM-guided biopsy has shown high success rates and shorter procedure times compared to MRI-guided biopsies, but its availability is limited. CEM is also being evaluated for evaluating symptomatic breast complaints, pre-surgical staging of breast cancer, and neoadjuvant therapy response assessment. Recent meta-analyses indicate that CEM has similar sensitivity and specificity to contrast-enhanced breast MRI, making it a viable alternative in dense breasts. AI and radiomics are showing promise in aiding CEM interpretation and improving diagnostic accuracy. Despite its potential, CEM faces challenges such as increased radiation exposure, workflow considerations, and reimbursement issues. Prospective, multi-center clinical trials, such as the Contrast Enhanced Mammography Imaging Screening Trial (CMIST), will further inform its clinical implementation.Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with potential applications in screening, diagnosis, and procedural guidance. This review summarizes recent literature, including retrospective studies, prospective clinical trials, and meta-analyses published from 2020 to 2023, to provide an updated overview of the current state-of-the-art in CEM. CEM provides 8 standard images, including low-energy and post-contrast recombined views, which can improve visualization of cancers in dense breasts. While CEM exposes individuals to ionizing radiation and requires intravenous contrast administration, recent studies suggest that its diagnostic performance is superior to other mammographic techniques. CEM-guided biopsy has shown high success rates and shorter procedure times compared to MRI-guided biopsies, but its availability is limited. CEM is also being evaluated for evaluating symptomatic breast complaints, pre-surgical staging of breast cancer, and neoadjuvant therapy response assessment. Recent meta-analyses indicate that CEM has similar sensitivity and specificity to contrast-enhanced breast MRI, making it a viable alternative in dense breasts. AI and radiomics are showing promise in aiding CEM interpretation and improving diagnostic accuracy. Despite its potential, CEM faces challenges such as increased radiation exposure, workflow considerations, and reimbursement issues. Prospective, multi-center clinical trials, such as the Contrast Enhanced Mammography Imaging Screening Trial (CMIST), will further inform its clinical implementation.