Computer-Aided Detection did not improve Digital Screening Mammography's Diagnostic Accuracy

Lehman et al in a paper published by JAMAInternal Medicine report on their findings that suggest that computer-assisted detection (CAD) used in most mammograms added no benefit to breast cancer screening while it substantially increased costs.

The authors compared the accuracy of digital screening mammography interpreted with (n = 495 818) versus without (n = 129 807) CAD from 2003 through 2009 in 323 973 women.  271 radiologists in 66 facilities interpreted the mammographic studies.  They found 3159 breast cancers within 1 year of the screening.

Screening performance was not improved with CAD on any metric assessed. Mammography sensitivity was 85.3% with and 87.3% without CAD. Specificity was 91.6% with and 91.4% without CAD. There was no difference in cancer detection rate (4.1 in 1000 women screened with and without CAD). Computer-aided detection did not improve intra-radiologist performance. Sensitivity was significantly lower for mammograms interpreted with versus without CAD in the subset of radiologists who interpreted both with and without CAD.

The authors concluded CAD does not improve diagnostic accuracy of mammography. These results suggest that while insurers pay an additional $400 million a year for CAD, its addition to standard mammography had no beneficial impact to women.

American Cancer Society Updated Guidelines for Breast Cancer Screening

Breast cancer is a leading cause of premature mortality among US women.   Oeffinger at al report in JAMA the American Cancer Society (ACS) 2015 update regarding the frequency of screening mammography in women at average risk. 

The ACS recommends that women with an average risk of breast cancer should undergo annual screening mammography starting at age 45 years (strong recommendation).

Women 55 years and older should transition to biennial screening (strong recommendation).

Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).

Women should have the opportunity to have annual screening between at the ages of 40-45 received a qualified recommendation.

The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer.