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.
Design:
Retrospective cohort study.
Setting:
Medicare program.
Participants:
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).
Measurements:
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]).
Limitation:
Short follow-up for cancer stage, potential unmeasured confounding, and uncertain generalizability to younger women.
Conclusion:
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.
Primary Funding Source:
Center for Healthcare Policy and Research, University of California, Davis.
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Author, Article and Disclosure Information
From the Center for Healthcare Policy and Research and Comprehensive Cancer Center, University of California, Davis, Sacramento, California; City of Hope Medical Center, Duarte, California; and the University of Washington, Seattle, Washington.
Grant Support: By the Clinical and Translational Science Center and Center for Healthcare Policy and Research, University of California, Davis, and the National Cancer Institute (K05 CA-104699).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2025.
Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Fenton (e-mail, joshua.
Corresponding Author: Joshua J. Fenton, MD, MPH, University of California, Davis, Department of Family and Community Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817; e-mail, joshua.
Current Author Addresses: Dr. Fenton: University of California, Davis, Department of Family and Community Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817.
Dr. Xing: University of California, Davis, Center for Healthcare Policy & Research, 2103 Stockton Boulevard, Suite 2224, Sacramento, CA 95817.
Dr. Elmore: University of Washington, Division of General Internal Medicine, Harborview Medical Center, Box 359780 10EH15, 325 9th Avenue, Seattle, WA 98104.
Dr. Bang: University of California, Davis, Division of Biostatistics, Med Sci 1-C, One Shields Avenue, Davis, CA 95616.
Dr. Chen: City of Hope Medical Center, 1500 Duarte Road, Duarte, CA 91010.
Dr. Lindfors: University of California, Davis, Department of Radiology, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817.
Dr. Baldwin: University of Washington, Department of Family Medicine, Box 354982, Seattle, WA 98195-4982.
Author Contributions: Conception and design: J.J. Fenton, J.G. Elmore, S.L. Chen, K.K. Lindfors.
Analysis and interpretation of the data: J.J. Fenton, G. Xing, H. Bang, S.L. Chen, K.K. Lindfors, L.M. Baldwin.
Drafting of the article: J.J. Fenton, J.G. Elmore, H. Bang, K.K. Lindfors.
Critical revision of the article for important intellectual content: J.J. Fenton, J.G. Elmore, S.L. Chen, K.K. Lindfors, L.M. Baldwin.
Final approval of the article: J.J. Fenton, J.G. Elmore, H. Bang, S.L. Chen, K.K. Lindfors, L.M. Baldwin.
Statistical expertise: G. Xing, H. Bang.
Obtaining of funding: J.J. Fenton.
Administrative, technical, or logistic support: J.J. Fenton, S.L. Chen.
Collection and assembly of data: S.L. Chen.
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