Mammography Alone Just As Good As Mammography with CAD

October 26, 2015

Mammography alone is just as good as mammography with CAD, and less expensive, for detecting breast cancer.

Computer-aided mammography was not associated with increased cancer detection, according to a study published in JAMA Internal Medicine.

Researchers from Massachusetts General Hospital in Boston; Group Health Research Institute in Seattle, WA; University of California in San Francisco; Norris Cotton Cancer Center, Geisel School of Medicine in Dartmouth, NH; and the School of Medicine, University of California in Davis, sought to measure the performance of digital screening mammography with and without CAD in US community practice.

A total of 625,625 mammograms (495,818 with CAD, 129,807 without) from 323,973 women, interpreted by 271 radiologists, were included in the study. Linkages with tumor registries identified 3,159 breast cancers among the women within one year of the screening. Mammography performance was analyzed, based on sensitivity, specificity, and cancer detection rates per 1,000 women.

 With CADWithout CAD
Mammography sensitivity85.3% (95%CI, 83.6%-86.9%)87.3% (95%CI, 84.5%-89.7%)
Mammography specificity91.6% (95%CI, 91.0%-92.2%)91.4% (95%CI, 90.6%-92.0%)
Cancer detection rate4.1 per 1,000 women4.1 per 1,000 women
Invasive cancer detection rate2.9 per 1,000 women3.0 per 1,000 women

 “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 results of our comprehensive study lend no support for continued reimbursement for CAD as a method to increase mammography performance or improve patient outcomes,” the authors concluded.[[{"type":"media","view_mode":"media_crop","fid":"42673","attributes":{"alt":"mammography","class":"media-image media-image-right","id":"media_crop_5377920123385","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4642","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 107px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©zlikovec/","typeof":"foaf:Image"}}]]

Joshua J. Fenton, MD, MPH, of the University of California, Davis Health System, Sacramento discussed CAD payment in a related commentary: “If the CMS [Centers for Medicare and Medicaid Services] were to consider a proposal for new CAD coverage at this time, the current evidence base would not support approval. 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.”