title: Effectiveness of computer-aided detection in community mammography practice.
abstract: BACKGROUND
  Computer-aided detection (CAD) is applied during screening mammography for millions of US women annually, although it is uncertain whether CAD improves breast cancer detection when used by community radiologists.
  
  
  METHODS
  We investigated the association between CAD use during film-screen screening mammography and specificity, sensitivity, positive predictive value, cancer detection rates, and prognostic characteristics of breast cancers (stage, size, and node involvement). Records from 684 956 women who received more than 1.6 million film-screen mammograms at Breast Cancer Surveillance Consortium facilities in seven states in the United States from 1998 to 2006 were analyzed. We used random-effects logistic regression to estimate associations between CAD and specificity (true-negative examinations among women without breast cancer), sensitivity (true-positive examinations among women with breast cancer diagnosed within 1 year of mammography), and positive predictive value (breast cancer diagnosed after positive mammograms) while adjusting for mammography registry, patient age, time since previous mammography, breast density, use of hormone replacement therapy, and year of examination (1998-2002 vs 2003-2006). All statistical tests were two-sided.
  
  
  RESULTS
  Of 90 total facilities, 25 (27.8%) adopted CAD and used it for an average of 27.5 study months. In adjusted analyses, CAD use was associated with statistically significantly lower specificity (OR = 0.87, 95% confidence interval [CI] = 0.85 to 0.89, P < .001) and positive predictive value (OR = 0.89, 95% CI = 0.80 to 0.99, P = .03). A non-statistically significant increase in overall sensitivity with CAD (OR = 1.06, 95% CI = 0.84 to 1.33, P = .62) was attributed to increased sensitivity for ductal carcinoma in situ (OR = 1.55, 95% CI = 0.83 to 2.91; P = .17), although sensitivity for invasive cancer was similar with or without CAD (OR = 0.96, 95% CI = 0.75 to 1.24; P = .77). CAD was not associated with higher breast cancer detection rates or more favorable stage, size, or lymph node status of invasive breast cancer.
  
  
  CONCLUSIONS
  CAD use during film-screen screening mammography in the United States is associated with decreased specificity but not with improvement in the detection rate or prognostic characteristics of invasive breast cancer.
authors.affiliation: Department of Family and Community Medicine and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA 95817, USA. joshua.fenton@ucdmc.ucdavis.edu
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Fenton
authors.forename: Linn
authors.initials: L
authors.lastname: Abraham
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Taplin
authors.forename: Berta M
authors.initials: BM
authors.lastname: Geller
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.forename: Carl
authors.initials: C
authors.lastname: D'Orsi
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000517:prevention & control*; D015986:Confounding Factors, Epidemiologic; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000191:economics / Q000379:methods; D008499:Medical Records; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011314:Preventive Health Services / Q000379:methods* / Q000592:standards; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States