Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with potential applications in screening, diagnosis, and procedural guidance. This review summarizes recent peer-reviewed literature from 2020 to 2023, focusing on retrospective reviews, prospective clinical trials, and meta-analyses. CEM provides 8 standard images, including low-energy and post-contrast recombined views, which may offer improved visualization of cancers compared to standard 2D mammography. CEM is being evaluated for use in assessing the extent of disease in newly diagnosed breast cancers, troubleshooting diagnostic dilemmas, and evaluating neoadjuvant therapy response. However, CEM is not without limitations, including exposure to ionizing radiation, potential contrast reactions, and challenges in detecting abnormal enhancement in cases of elevated background parenchymal enhancement. CEM-guided biopsy is a new clinical application, showing high success rates and lower lesion non-visualization rates compared to MRI-guided biopsies. CEM has potential for increased accessibility and shorter procedure times compared to MRI. However, it is associated with increased radiation exposure, though within acceptable limits. CEM has shown comparable diagnostic performance to MRI and ultrasound in evaluating symptomatic breast complaints and palpable masses. In pre-surgical staging of breast cancer, CEM has demonstrated the ability to detect additional lesions and alter surgical planning, though MRI remains more sensitive for detecting additional foci of malignancy. CEM is being evaluated as an alternative to MRI for breast cancer screening, particularly in dense breast tissue, with similar sensitivity and accuracy. CEM may offer improved evaluation of the extent of disease compared to 2D mammography, tomosynthesis, and ultrasound. Recent studies suggest that CEM may be a viable alternative to MRI for screening in dense breasts, with potential cost savings for healthcare systems. CEM is also being evaluated for use in individuals with breast implants and for evaluating indeterminate findings on other diagnostic breast imaging studies. CEM has shown potential in neoadjuvant therapy response assessment, with studies indicating its ability to detect residual disease. However, CEM may have lower specificity for calcified lesions and may slightly over- or underestimate lesion size depending on the imaging technique used. CEM is being evaluated for use in breast cancer screening for individuals with dense breast tissue and intermediate lifetime risk of breast cancer, with studies suggesting it is a viable alternative to MRI for supplemental screening. CEM is also being evaluated for use in surveillance of breast cancer following definitive surgical treatment, with studies indicating its potential for detecting recurrence. CEM has shown comparable diagnostic performance to MRI in evaluating breast cancer in patients with minimal to mild background parenchymal enhancement. Artificial intelligence is being explored to aid in CEM interpretation, with studies showing high accuracy in differentiating benign from malignant lesions. Despite its potential, CEM faces challenges in clinical implementation, including risks of iodinated contrast media, increased radiation exposure, workflow considerations, and the need for additionalContrast-enhanced mammography (CEM) is an emerging breast imaging technology with potential applications in screening, diagnosis, and procedural guidance. This review summarizes recent peer-reviewed literature from 2020 to 2023, focusing on retrospective reviews, prospective clinical trials, and meta-analyses. CEM provides 8 standard images, including low-energy and post-contrast recombined views, which may offer improved visualization of cancers compared to standard 2D mammography. CEM is being evaluated for use in assessing the extent of disease in newly diagnosed breast cancers, troubleshooting diagnostic dilemmas, and evaluating neoadjuvant therapy response. However, CEM is not without limitations, including exposure to ionizing radiation, potential contrast reactions, and challenges in detecting abnormal enhancement in cases of elevated background parenchymal enhancement. CEM-guided biopsy is a new clinical application, showing high success rates and lower lesion non-visualization rates compared to MRI-guided biopsies. CEM has potential for increased accessibility and shorter procedure times compared to MRI. However, it is associated with increased radiation exposure, though within acceptable limits. CEM has shown comparable diagnostic performance to MRI and ultrasound in evaluating symptomatic breast complaints and palpable masses. In pre-surgical staging of breast cancer, CEM has demonstrated the ability to detect additional lesions and alter surgical planning, though MRI remains more sensitive for detecting additional foci of malignancy. CEM is being evaluated as an alternative to MRI for breast cancer screening, particularly in dense breast tissue, with similar sensitivity and accuracy. CEM may offer improved evaluation of the extent of disease compared to 2D mammography, tomosynthesis, and ultrasound. Recent studies suggest that CEM may be a viable alternative to MRI for screening in dense breasts, with potential cost savings for healthcare systems. CEM is also being evaluated for use in individuals with breast implants and for evaluating indeterminate findings on other diagnostic breast imaging studies. CEM has shown potential in neoadjuvant therapy response assessment, with studies indicating its ability to detect residual disease. However, CEM may have lower specificity for calcified lesions and may slightly over- or underestimate lesion size depending on the imaging technique used. CEM is being evaluated for use in breast cancer screening for individuals with dense breast tissue and intermediate lifetime risk of breast cancer, with studies suggesting it is a viable alternative to MRI for supplemental screening. CEM is also being evaluated for use in surveillance of breast cancer following definitive surgical treatment, with studies indicating its potential for detecting recurrence. CEM has shown comparable diagnostic performance to MRI in evaluating breast cancer in patients with minimal to mild background parenchymal enhancement. Artificial intelligence is being explored to aid in CEM interpretation, with studies showing high accuracy in differentiating benign from malignant lesions. Despite its potential, CEM faces challenges in clinical implementation, including risks of iodinated contrast media, increased radiation exposure, workflow considerations, and the need for additional