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Computer aided mammography gets ahead of the evidence

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2387 (Published 17 April 2013) Cite this as: BMJ 2013;346:f2387

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Many radiologists in developed countries use computer algorithms to help interpret screening mammograms. Such algorithms may be contributing to overdiagnosis, according to a large cohort study from the US. In adjusted analyses, use of the technology in women aged 65 or over was associated with a higher incidence of ductal carcinoma in situ (adjusted odds ratio, 1.17, 95% CI 1.11 to 1.23) but not invasive breast cancer. Computer aided detection also increased the odds of further investigations, including biopsies (1.10, 1.08 to 1.12), in women without cancer.

Researchers linked three US administrative databases to examine the balance of benefits and risks in 163 099 older women screened between 2001 and 2006. Computer aided detection spread rapidly during that time, and by 2006 more than 60% of screening mammograms were reported this way. Cancers detected using computer algorithms were at an earlier stage than those detected without them (adjusted odds of stage I v stages II-IV: 1.15, 1.09 to 1.22), but secondary analyses failed to find a longer term reduction in late stage cancers. It’s much too early to say whether computed aided detection can prolong the lives of women screened at age 65 or over, write the researchers. Their cohort excluded younger women.

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Cite this as: BMJ 2013;346:f2387