Computer-Aided Detection (CAD) that uses software designed to improve how radiologists interpret mammograms may instead make readings less accurate, according to new research. Use of CAD did not clearly improve the detection of breast cancer. The research was conducted by investigators at the University of California Davis Health System, Sacramento, Calif., and colleagues in the Breast Cancer Surveillance Consortium, which is sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health.

The results of the study show that women who got screening mammograms at centers using CAD devices were more likely to be told their mammogram was abnormal and thus undergo a biopsy to rule out breast cancer. Findings appear in the April 5, 2007 issue of the New England Journal of Medicine and were funded by NCI, the Agency for Healthcare Research and Quality, and the American Cancer Society.

CAD software analyzes the mammogram image and marks suspicious areas for radiologists to review, thus assisting them in determining which images could lead to in serious tumors. CAD was approved by the U.S. Food and Drug Administration in 1998 and has been incorporated into many mammography imaging practices, but its effect on the accuracy of interpretation has been unclear.
"This study points out the need for the use of other techniques to find cancer at its earliest stages. NCI is incorporating techniques for imaging at the molecular level into many of its studies and is also conducting studies to improve the use of CAD and conventional mammography," said John E. Niederhuber, M.D., NCI Director. "In the end, technology facilitates screening. Ultimately, treatment requires radiologists working with the examining physician and the responsible surgeon to put everything together. We worry about false positives, but we certainly don't want to miss any cancers, either."

Investigators looked at the use of screening mammography in 222,135 women who had 429,345 mammograms. The period of observation was from 1998 through 2002 and took place at 43 facilities in Colorado, New Hampshire, and Washington states. The study included 2,351 women who received a diagnosis of breast cancer within one year after screening and also received a mammogram that did or did not use CAD.

"Within three years of FDA approval, 10 percent of the mammography facilities in the country were using CAD," said lead researcher Joshua J. Fenton, M.D., UC Davis Health System. "There had been no large-scale community-based review of CAD efficacy despite the rapid adoption of this technology so we did this study to see if CAD was proving to be beneficial."

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