CAD use for digital screening mammography remains stable

In the last 10 years, the Breast Cancer Surveillance Consortium (BCSC) has released numerous studies that show computer-aided detection (CAD) for screening mammography can lead to decreased radiologist reading accuracy. According to a recent study published by the Journal of the American College of Radiology, however, CAD use at digital screening mammography facilities remained stable from 2008 to 2016.

The study’s authors thought CAD use in such facilities might decrease due to the BCSC’s research, but that turned out not to be the case. Using the FDA’s database of certified mammography facilities and a heavy dose of phone calls and online research, they found that the mean proportion of digital facilities using CAD was 91.4 percent in 2008, 90.2 percent in 2011, and 92.3 percent in 2016.

So why have facilities continued to use CAD? Lead author John D. Keen MD, MBA, with John H. Stroger Jr. Hospital of Cook County in Chicago, and colleagues put forth a few ideas. First, they say, radiologists believe CAD is useful for detecting microcalcifications. In addition, radiologists “may just not be aware of, or accept, the BCSC-based evidence,” instead focusing on other, more positive statistics.

“Although CAD appeared promising in earlier studies, in our review of the CAD literature, we could not identify recent peer-reviewed journal articles that report results different from the BCSC,” the authors wrote. “However, this does not mean that less-skilled radiologists cannot learn to use CAD better or that CAD cannot be improved in the future.”

Keen and colleagues also noted that some BCSC data showed that CAD can lead to a higher detection rate of ductal carcinoma in situ (DCIS) and there is “considerable disagreement in the medical community on the value of detecting DCIS through screening.” One side of the debate thinks performance goals should focus on invasive cancers over DCIS, but the other side says “increased DCIS detection correlates with a decreased interval cancer rate and increased detection of small invasive tumors.”