A widely used and expensive computer system created to help radiologists identify suspicious spots on mammograms may not help detect breast cancer, new research suggests. The study, led by Dr. Joshua J. Fenton of the University of California, Davis, appeared online July 27 in the Journal of the National Cancer Institute (JNCI).
In the first large clinical study to assess the performance of computer-aided detection (CAD) in the United States, the technology did not improve the detection of invasive breast cancer. The finding was based on data from approximately 684,000 women and more than 1.6 million mammograms administered at Breast Cancer Surveillance Consortium facilities between 1998 and 2006.
CAD systems are now used to help interpret most screening mammograms in the United States, with annual direct Medicare costs in excess of $30 million, the study authors noted. The Food and Drug Administration approved the technology in 1998 based on limited data, and Medicare began to pay for CAD soon after.
In 2007, the investigators published preliminary results from this population-based observational study. At that time, they found that the use of CAD led to a substantially higher false-positive rate compared with the false-positive rate of radiologists who read mammograms without CAD.
The updated analysis included nearly twice the amount of data that were assessed in the 2007 preliminary study, but the conclusion was essentially the same. As the editors of JNCI summarized, the health benefits of using CAD to interpret screening mammograms “remain unclear, and the data indicate that the associated costs may outweigh the potential benefits.”
CAD technology is popular, in part, because the devices are built into digital mammography systems, which are increasingly common in the United States. Another reason is the financial incentive from Medicare reimbursement, noted Dr. Donald Berry of the University of Texas M. D. Anderson Cancer Center in an accompanying editorial.
Researchers and device companies should work to improve the system, Dr. Berry continued. “But this should happen in an experimental setting and not while exposing millions of women to a technology that may be more harmful than it is beneficial. In the meantime, economic incentives may stoke its continued proliferation.”
Further reading: 'Mammogram Study Evaluates Computer-Aided Detection' ► NCI Cancer Bulletin for April 17, 2007 (HTML) - National Cancer Institute: "- Enviado mediante la barra Google"
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