Effectiveness of computer-aided detection in community mammography practice

Joshua J. Fenton, Linn Abraham, Stephen H. Taplin, Berta M. Geller, Patricia (Patty) Carney, Carl D'Orsi, Joann G. Elmore, William E. Barlow

Research output: Contribution to journalArticle

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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 filmscreen 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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)1152-1161
Number of pages10
JournalJournal of the National Cancer Institute
Volume103
Issue number15
DOIs
StatePublished - Aug 3 2011

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Mammography
Breast Neoplasms
Confidence Intervals
Motion Pictures
Carcinoma, Intraductal, Noninfiltrating
Hormone Replacement Therapy
Registries
Neoplasms
Logistic Models
Lymph Nodes
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Fenton, J. J., Abraham, L., Taplin, S. H., Geller, B. M., Carney, P. P., D'Orsi, C., ... Barlow, W. E. (2011). Effectiveness of computer-aided detection in community mammography practice. Journal of the National Cancer Institute, 103(15), 1152-1161. https://doi.org/10.1093/jnci/djr206

Effectiveness of computer-aided detection in community mammography practice. / Fenton, Joshua J.; Abraham, Linn; Taplin, Stephen H.; Geller, Berta M.; Carney, Patricia (Patty); D'Orsi, Carl; Elmore, Joann G.; Barlow, William E.

In: Journal of the National Cancer Institute, Vol. 103, No. 15, 03.08.2011, p. 1152-1161.

Research output: Contribution to journalArticle

Fenton, JJ, Abraham, L, Taplin, SH, Geller, BM, Carney, PP, D'Orsi, C, Elmore, JG & Barlow, WE 2011, 'Effectiveness of computer-aided detection in community mammography practice', Journal of the National Cancer Institute, vol. 103, no. 15, pp. 1152-1161. https://doi.org/10.1093/jnci/djr206
Fenton, Joshua J. ; Abraham, Linn ; Taplin, Stephen H. ; Geller, Berta M. ; Carney, Patricia (Patty) ; D'Orsi, Carl ; Elmore, Joann G. ; Barlow, William E. / Effectiveness of computer-aided detection in community mammography practice. In: Journal of the National Cancer Institute. 2011 ; Vol. 103, No. 15. pp. 1152-1161.
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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 filmscreen 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. Conclusion 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.",
author = "Fenton, {Joshua J.} and Linn Abraham and Taplin, {Stephen H.} and Geller, {Berta M.} and Carney, {Patricia (Patty)} and Carl D'Orsi and Elmore, {Joann G.} and Barlow, {William E.}",
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AU - Fenton, Joshua J.

AU - Abraham, Linn

AU - Taplin, Stephen H.

AU - Geller, Berta M.

AU - Carney, Patricia (Patty)

AU - D'Orsi, Carl

AU - Elmore, Joann G.

AU - Barlow, William E.

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N2 - 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 filmscreen 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. Conclusion 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.

AB - 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 filmscreen 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. Conclusion 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.

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