Computers Search for Early Breast Cancers

Breast cancers detected earlier with technology that also increased diagnostic test referrals

(RxWiki News) Suspicious looking areas on a mammogram are hard to interpret. That’s why computer technology is used as a second pair of eyes. This technology has definite benefits, according to a new study, along with some potential disadvantages.

Study results showed that computer-aided detection (CAD) was very good for detecting breast cancer at earlier stages. That’s the advantage.

The not-so-good news is that CAD also increased the number of diagnostic tests women without cancer receive.

"Find out which breast cancer screening makes sense for you."

Joshua J. Fenton, MD, MPH, associate professor of Family and Community Medicine at the University of California, Davis, led a study evaluating the impact of using CAD with screening mammography.

According to the authors, most radiologists use CAD to highlight and review potentially suspicious lesions that may have been missed on the first mammogram reading.

Researchers reviewed health records for 164,000 women aged 67 to 89 years who received almost 410,000 mammograms.

The goal of the review was to determine associations between CAD use and the incidence of ductal carcinoma in situ (DCIS) and invasive breast cancer, invasive cancer stage and referral to further diagnostic testing.

CAD was associated with more DCIS. However, the technology found no difference in the incidence of invasive breast cancer.

The technology also increased referrals for more diagnostic testing among women who did not have breast cancer. These tests included diagnostic mammography, ultrasounds and biopsies.

“Use of CAD during screening mammography among Medicare enrollees is associated with increased DCIS incidence, the diagnosis of invasive breast cancer at earlier stages, and increased diagnostic testing among women without breast cancer,” the authors concluded.

Daniel B Kopans, MD, professor of radiology at Harvard Medical School and senior radiologist in the Breast Imaging Division at Massachusetts General Hospital, told dailyRx News that the study design was flawed. The participants were not randomly assigned to have either CAD or screening mammography alone.

“Furthermore, the authors have no idea which cancers were detected as a result of CAD and which were detected despite having CAD. These are major issues in trying to determine the value of CAD,” Dr. Kopans said.

He continued, “This paper did show that in the CAD era, the size of invasive cancers was reduced. Finding cancers at a smaller size and earlier stage will save lives. The bottom line is that this study does not really tell us the benefit of CAD since we do not know how many cancers would have been missed had CAD not been employed."

The study authors said the long-term effect of CAD on breast cancer stage, mortality, quality of life and costs needs more study.

Findings from this research were published April 15 in the Annals of Internal Medicine.

Funding for this research came from the Center for Healthcare Policy and Research; University of California, Davis; City of Hope Medical Center, Duarte, California; and the University of Washington, Seattle, Washington.

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Review Date: 
April 15, 2013