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Mammogram Researchers Dubious About CAD

April 17, 2013
Written by: , Filed in: Breast Imaging
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Radiologists who use computer-assisted detection while reading mammograms do find more cancers, according to a new study—although some of those cancers don’t actually exist.

False positives aside, the study concludes that most of the real extra cancers found with the help of CAD were ductal carcinoma in situ, which the researchers seemed to consider barely worth detecting.

“DCIS progresses slowly, if at all,” said lead author Joshua Fenton, MD. “Some of these early noninvasive lesions may never have come to clinical attention in women’s lifetimes if CAD were not applied to their mammograms.” (It’s worth noting that all of the study subjects were Medicare age and thus would have shorter presumptive lifetimes than younger mammogram recipients.)

Dr. Fenton is an associate professor of family and community medicine at UC Davis Health System in Sacramento, California. He was quoted in a UC Davis news release. The study appears in the April 16 issue of Annals of Internal Medicine.

The study also found that CAD was associated with a small increase in detection of early-stage invasive breast cancer. Dr. Fenton commented:

There may be benefits if CAD detects early-stage invasive cancer before it progresses. A longer-term study would be needed to see whether fewer women die of breast cancer on account of the technology.

CAD has been adopted widely since Medicare began reimbursing for it in 2001. Dr. Fenton estimated that Medicare pays more than $100 million a year for CAD.

The study looked at 409,459 mammograms done for 163,099 women in the U.S. Surveillance, Epidemiology and End Results cancer database. The women were ages 67 through 89. During the study period of 2001 through 2006, CAD use increased from 3.6 percent to 60.5 percent.

Compared to women screened without CAD, those screened with CAD had 17 percent more diagnoses of DCIS and 6 percent more diagnoses of early-stage invasive breast cancer. Women who turned out not to have breast cancer were 19 percent more likely to be called back for additional diagnostic imaging when CAD was used and 10 percent more likely to be given a breast biopsy.

Summing up, Fenton said, “CAD is expensive technology that has been nearly universally adopted in the U.S. due to Medicare’s support and the hope that it can help us identify and treat invasive breast cancer early. Our study suggests that we still don’t know whether the benefits outweigh the harms for the average woman on Medicare.”

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Nanodiamonds may be a triple-negative breast cancer patient’s best friend. For details, see our Facebook page.

Related seminar: Chicago International Breast Course and The Society for the Advancement of Women’s Imaging

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