Computer-Aided Detection for Mammography -- Not as Helpful in Detecting Breast Cancer as We Thought

Did hospitals jump the gun on purchasing expensive Computer-Aided Detection programs to assist radiologists in interpreting mammograms?

Unfortunately, it looks like the answer is yes, according to a new study of CAD for mammography in the New England Journal of Medicine. Not only did the unproven technology cost a lot of money, it did nothing to improve radiologists' ability to find tumors, which was the whole point of buying them. The use of computer-aided detection systems also increased the number of false alarms, meaning that many more women needlessly worried about a questionable lump or other red flag.

The NEJM study, the largest computer-aided detection study to date, evaluated performance on 429,000 mammograms.

Here's a little background on computer-aided detection, taken straight from the Web sites of two of the largest CAD vendors, R2 (Hologic) and iCAD. Keep in mind that this information is intended to sell computer-aided detection systems to hospitals and hospital administrators.

From R2:

• R2's CAD algorithm provides the best overall performance in the industry so you'll find more cancers and you'll find them earlier.
• R2 delivers the lowest false marker rate available, because sometimes the most important mark is no mark at all.
• Independent prospective studies from clinical sites have shown an 8-19% increase in cancer detection from academic^4,3 and community^1,2 practices, respectively, with the use of the ImageChecker system.

It looks like the folks at R2 knew about the problem of false alarms, and several smaller, prospective studies suggested a positive and helpful role for computer-aided detection.

From iCAD:

"With flexible options, reimbursement support and world-class customer service, our SecondLook® CAD systems are able to detect up to 68% of actionable missed breast cancers an average of 15 months earlier than screening mammography alone. This early detection helps save lives and often permits less costly, less invasive and less disfiguring treatment options than when breast cancer is detected at a later stage."

Follow the Money!

iCAD has a fascinating Web site, with sections focusing on how much hospitals can get paid (reimbursed from insurers and Medicaid/Medicare) if they use computer-aided detection.

Here is an interesting page on the iCAD site that breaks down what revenue a hospital can expect to receive, depending on how many patient cases are evaluated with computer-aided detection.

Here is R2's reimbursement page, which discusses their leading role in getting Medicare to start reimbursing hospitals if they used computer-aided detection in 2001:

"We’ve worked with over 400 commercial payors to secure coverage and reimbursement for CAD. We’re proud of the fact that we led the effort to secure Medicare reimbursement for CAD in 2001. We also influenced the increased payment rates for 2002 and 2003, obtained CPT code (76085) for screening CAD effective in 2002, and expanded the scope of CPT code (76085) to include diagnostic CAD in 2003. In addition, we led the effort to obtain Medicare coding and reimbursement for CAD used with digital mammography for 2003."