Digital screening mammography is as accurate without computer-aided detection (CAD) as it is with the technology, according to a study published September 28 online ahead of print in JAMA Internal Medicine. 


Constance D. Lehman, MD, PhD, and colleagues studied more than 625,000 mammograms with (n=495,818) or without (n=129,807) CAD that were performed on 323,973 women. Within one year of screening, 3,159 cases of breast cancer were identified. CAD was not associated with improvement in screening performance.


Mammography with CAD had a sensitivity of 85.3%, whereas it was 87.3% without CAD; specificity was 91.6% with CAD and 91.4% without CAD. The researchers observed no difference in the overall rate of detection of breast cancer (4.1 per 1,000 women screened with and without CAD) or in the rate for the detection of invasive breast cancers (2.9 vs. 3.0 per 1,000 women screened with or without CAD, respectively). 


Mammography with CAD became widely used following a decision from the Centers for Medicare and Medicaid Services (CMS) to provide increased reimbursements for the technology in 2002. However, data on the value of CAD are limited, the authors said. “Computer-aided detection does not improve the diagnostic accuracy of mammography,” they concluded in their study.