title: Short-term outcomes of screening mammography using computer-aided detection: a population-based study of medicare enrollees.
abstract: BACKGROUND
  Computer-aided detection (CAD) has rapidly diffused into screening mammography practice despite limited and conflicting data on its clinical effect.
  
  
  OBJECTIVE
  To determine associations between CAD use during screening mammography and the incidence of ductal carcinoma in situ (DCIS) and invasive breast cancer, invasive cancer stage, and diagnostic testing.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Medicare program.
  
  
  METHODS
  Women aged 67 to 89 years having screening mammography between 2001 and 2006 in U.S. SEER (Surveillance, Epidemiology and End Results) regions (409 459 mammograms from 163 099 women).
  
  
  METHODS
  Incident DCIS and invasive breast cancer within 1 year after mammography, invasive cancer stage, and diagnostic testing within 90 days after screening among women without breast cancer.
  
  
  RESULTS
  From 2001 to 2006, CAD prevalence increased from 3.6% to 60.5%. Use of CAD was associated with greater DCIS incidence (adjusted odds ratio [OR], 1.17 [95% CI, 1.11 to 1.23]) but no difference in invasive breast cancer incidence (adjusted OR, 1.00 [CI, 0.97 to 1.03]). Among women with invasive cancer, CAD was associated with greater likelihood of stage I to II versus III to IV cancer (adjusted OR, 1.27 [CI, 1.14 to 1.41]). In women without breast cancer, CAD was associated with increased odds of diagnostic mammography (adjusted OR, 1.28 [CI, 1.27 to 1.29]), breast ultrasonography (adjusted OR, 1.07 [CI, 1.06 to 1.09]), and breast biopsy (adjusted OR, 1.10 [CI, 1.08 to 1.12]).
  
  
  CONCLUSIONS
  Short follow-up for cancer stage, potential unmeasured confounding, and uncertain generalizability to younger women.
  
  
  CONCLUSIONS
  Use of CAD during screening mammography among Medicare enrollees is associated with increased DCIS incidence, the diagnosis of invasive breast cancer at earlier stages, and increased diagnostic testing among women without breast cancer.
  
  
  BACKGROUND
  Center for Healthcare Policy and Research, University of California, Davis.
authors.affiliation: University of California, Davis, Department of Family and Community Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817, USA. joshua.fenton@ucdmc.ucdavis.edu
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Fenton
authors.forename: Guibo
authors.initials: G
authors.lastname: Xing
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
authors.forename: Heejung
authors.initials: H
authors.lastname: Bang
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chen
authors.forename: Karen K
authors.initials: KK
authors.lastname: Lindfors
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods*; D006278:Medicare; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States / Q000453:epidemiology