Expense of Computer-Assisted Mammography Not Justified

Lots of mammography labs promote the latest technology to detect suspicious images on breast scans, but according to a recent study, the computer-assisted diagnosis is no better at screening for breast cancer.  But it is more expensive.

As reported recently by the Associated Press (AP), the study published in JAMA Internal Medicine followed nearly 324,000 women who had digital mammograms between 2003 and 2009. The researchers analyzed cancer detection rates from scans with and without computer-assisted technology. About 1 in 5 scans were of the lower-tech variety.

The results were similar for both groups: Cancer was detected in about 4 in 1,000 women.

The technology amounts to special software that highlights suspicious-looking areas on a mammogram image that radiologists might have missed. The highlights draw doctors’ attention back for a closer look before they make a final determination.

Earlier studies suggested that digital scans were a notable improvement, but, according to the study authors, some of that research added computer detection to mammograms using outdated film X-rays instead of the more advanced digital X-rays more commonly used now.

According to AP, “Computer-assisted scans did prove to be slightly better at detecting very early tumors called ductal carcinoma in situ or DCIS, but whether that is a benefit is debatable because these tumors are not invasive and some experts think they should not even be considered true cancers.” (See our blog, “Bad Advice Abounds Regarding Surgery for DCIS.” )

So the cool new technology’s main attribute, at least for screening (not treatment) purposes, might be that it finds lesions that probably aren’t significant as a cancer threat or to the woman’s overall health. As readers of this blog know, that’s a recipe for overtreatment, which is good only for providers who get paid to conduct unnecessary procedures.

Although screening mammograms are considered preventive care covered by insurance plans that fall under the Affordable Care Act (“Obamacare”), which excuses patients from a copay, the fancier diagnosis costs the health system more. Do we want to spend our health-care resources on technology that isn’t demonstrably better?

Even JAMA ran an editorial accompanying its study that raised questions about continuing to use the technology for with screening mammograms.

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