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.