(This story was updated at 5:05 p.m. ET.)
Computer-aided detection for breast cancer screening was not associated with better identification of the disease, according to new study published today in JAMA Internal Medicine.
The latest study is part of a growing chorus that says the technology is not worth the millions it adds to U.S. healthcare costs. An accompanying editorial even questions whether the CMS should continue reimbursing for computer-aided detection, or CAD.
Researchers evaluated the results of 625,000 mammograms conducted by radiologists between 2003 and 2009.
The study found no difference in the overall cancer detection rate when comparing 495,000 screenings conducted using computer-aided detection with 129,000 mammograms done without CAD.
The study based its findings on several measures, including sensitivity, or the ability to correctly identify cancer, as well as specificity, or the ability to correctly detect when the disease was not present in a patient.
The analysis also looked at the success of screenings among 107 radiologists who interpreted mammograms both with and without CAD. It found that performance did not improve with computer-aided diagnosis and instead was associated with more missed breast cancer detections.
CAD is used in more than 90% of mammograms performed in the U.S.
“I think that we want to continue to have this kind of research being done so we don't invest our healthcare dollars in areas where it's not improving diagnostic performance,” said study lead author Dr. Constance Lehman, co-director of the Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital in Boston. “We want to make sure we are instead investing those healthcare dollars in areas that are actually improving performance and hopefully improving outcomes in our patients.”
The study based its findings on several measures, including the ability to correctly identify cancer as well as the ability to correctly detect when the disease was not present in a patient.
“In the era of choosing wisely and clear commitments to support technology that brings added value to the patient experience, while aggressively reducing waste and containing costs, CAD is a technology that does not seem to warrant added compensation beyond coverage of the mammographic examination,” the study concluded. “The results of our comprehensive study lend no support for continued reimbursement for CAD as a method to increase mammography performance or improve patient outcomes.”
In an accompanying editorial, Dr. Joshua Fenton, associate professor of family and community medicine at the UC Davis Health System, Sacramento, Calif., questioned whether it was time for the CMS to re-evaluate its coverage of CAD given the questions surrounding its efficacy and the more than $300 million per year in Medicare costs associated with its use.
“If the CMS were to consider a proposal for new CAD coverage at this time, the current evidence base would not support approval,” Fenton wrote. “Thus, we should question whether society should continue to pay for CAD use. … Congress should therefore rescind the Medicare benefit for CAD use. … The lesson of CAD is that broad societal investment in new medical technologies should occur only after large-sample evaluations prove their real-world effectiveness and justify their costs.”
Computer-aided detection for mammography was first approved by the U.S. Food and Drug Administration in 1998. It has since been scrutinized over its ability to detect cancers missed by other screening methods.
Computer-aided detection for mammography was first approved in 1998 by the U.S. Food and Drug Administration, but has come under scrutiny over its ability to detect cancers missed by other screening methods. Previous studies have been mixed in terms of CAD's ability to improve cancer detection.
An analysis conducted in 2013 published in the Annals of Internal Medicine found no difference in detection of invasive cancer with CAD, but the aid was associated with a higher incidence of detection of early-stage breast cancer.
CAD supporters point out the technology is meant to alert physicians of questionable areas in a mammogram, almost serving as a second pair of eyes.
“This is a topic that has been a bone of contention for 15 years now, and there is no definite answer out there yet,” said Dr. Davide Bova, medical director of diagnostic radiology at Loyola University Medical Center, Maywood, Ill. “I think we have an imperfect tool (CAD) that we probably need to invest more in trying to improve and see if we can bring it up to the same level of diagnostic performance, which is increase the sensitivity without compromising the specificity, to as close as possible to the diagnostic performance of a well-trained radiologist.”
In response to the study's findings, American College of Radiology's Breast Imaging Commission Chair Dr. Debra Monticciolo called the analysis a “good addition to the literature,” saying it will add to the ongoing discussion regarding the use of CAD.
"ACR positions on varying subjects are continually examined and updated as necessary," Monticciolo said. "Although only a single study, this information will certainly be useful in that process.”
