Computer programs designed to help radiologists could identify more cases of breast cancer, but also might increase the number of false-positive results, which can lead to biopsies in healthy women, according to a recent systematic review.
Using computer-aided detection (CAD) mammography, "you do catch some cases that would have been missed if the mammogram had been read only by a single radiologist," says review author Meredith Noble, a research analyst at ECRI Institute.
Based in Plymouth Meeting, Pa., ECRI Institute is a nonprofit international health services research agency that provides information and technical assistance to the health-care community.
Typically, a radiologist examines a woman's screening mammogram to check for signs of cancer.
When using CAD with mammography, the radiologist still reads the mammogram, but a computer program also evaluates the mammogram and marks suspicious areas for the radiologist to review further.
Investigators led by Noble synthesized data from seven previously published studies of CAD mammography's use in more than 392,000 healthy women with no lumps or other symptoms of breast cancer.
The review of that data, released last in December, is an update of an earlier review also published by ECRI Institute, which produces systematic evidence reviews on medical devices, drugs, biotechnologies, and procedures.
Investigators found that in women with no symptoms, screening with CAD mammography identified an estimated 84.2 percent to 87.6 percent of women with cancer, a finding referred to as test sensitivity.
In addition, an estimated 88.1 percent to 88.3 percent of healthy women correctly received negative test results when undergoing CAD mammography, a finding referred to as test specificity.
Researchers compared CAD mammography results to biopsy results and patient follow-up records to determine whether the women received a breast cancer diagnosis within a year after the mammogram.
The updated evidence review indicated that CAD mammography helped identify an estimated 50 additional cancer diagnoses for every 100,000 women who underwent the screening test, compared with having the mammogram read only by a radiologist.
The analysis also estimated that following CAD mammography, between 1,090 and 1,290 women per 100,000 healthy womenwomen who didn't have breast cancerwould be recalled for further testing in the form of more imaging studies or biopsy based on abnormal mammogram results.
ECRI Institute estimated that 80 of those women who had false-positive results would undergo biopsy.
Dr. Joshua Fenton, a researcher who focuses on breast cancer screening, says a concern "is that we may have variability in how doctors are using this technology." He said that some providers might simply rely on CAD to catch potentially cancerous areas, instead of interpreting the mammogram first and using CAD as a secondary analysis tool.
"That might result in a different outcome in the community," Fenton says.
Based on the evidence review, Fenton agrees with the authors that there aren't enough data to say for sure that CAD has clear public health benefits, that it improves breast cancer mortality, or that it helps doctors detect the most dangerous breast cancer.
Although the results of this evidence report pertain mainly to health-care providers, patients need to know about the advantages and potential drawbacks of CAD mammography, Noble says. Most notably, physicians should tell women who undergo CAD mammography screenings that there are more false positives when CAD is used.
False-positive findings can provoke anxiety, but some women and their doctors might find them to be an acceptable trade-off for identifying some additional cancers, Noble adds.
CAD mammography received approval by the U.S. Food and Drug Administration in 1998.
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