Breast CAD marketing exceeds real results

I read Greg Freiherr's column "Why the NEJM study on CAD is wrong" on your website. Please always keep in mind the following about computer-aided detection:

The potential value (i.e., cancer detection rate and tumor size at detection) of CAD will always be inversely proportional to the performance (i.e., cancer detection rate and tumor size at detection) of the radiologist.

Current cost for screening mammography cancer detection (using Medicare reimbursement rates for screening mammography only and cancer detection rate of four cancers/1000 patients) is $86 x 1000/4 = $21,500 per cancer detection.

If we wish to remain cost equivalent for the value of CAD for screening mammography cancer detection ($18/CAD examination), CAD will need to aid the radiologist in the detection of one additional cancer among 1194 patients (or result in a significant reduction in the average size of an invasive tumor for an equivalent number of cancer cases): $21,500/$18 = 1194 patients.

Several CAD reports within our current medical literature note that with experienced breast imagers, CAD helped identify one additional cancer per 4000 to 6000 patients. CAD cost/value ratio in this group would range: 4000 to 6000 x $18 = $72,000 to $108,000 per cancer detection.

Given my experience and research with CAD (most recent article, scheduled for publication in Oct./Nov. issue of Radiology, compared R2 and iCAD ability to detect ~220 invasive cancers without associated calcification measuring less than 16 mm), I believe CAD remains in its infancy but, with the correct research and development, could in the future potentially become the primary reader for screening mammography. Currently, CAD marketing and PR far exceed real clinical results for experienced breast imagers.

Richard L. Ellis, M.D.
Codirector, Norma J. Vinger
Center for Breast Care
La Crosse, WI