News | Mammography | September 28, 2015

UC Davis Researcher Advocates Ending Medicare Coverage of Controversial Mammography Tool

Editorial responds to study finding computed-aided detection did not improve, and even hampered, cancer detection in mammograms

UC Davis, Joshua Fenton, computer-aided diagnosis, mammograms, breast cancer, Constance D. Lehman

September 28, 2015 — A costly tool used on nearly all mammograms does not increase cancer detection rates and should no longer be covered by Medicare, argues Joshua Fenton, a family physician and comparative effectiveness researcher. Fenton’s editorial on the subject was published online Sept. 25 in the Journal of the American Medical Association Internal Medicine.

Fenton’s editorial responds to a study published in the same issue that announces findings from the largest study ever on computer-aided detection (CAD), a tool approved by the U.S. Food and Drug Administration nearly 20 years ago to help radiologists interpret screening mammograms by automatically marking potentially suspicious spots for further radiological review.

The study was led by Constance D. Lehman, M.D., Ph.D., currently director of breast imaging and co-director of the Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital in Boston, who conducted the research while at the University of Washington in Seattle. University of California Davis Dean’s Professor in Biostatistics Diana Miglioretti was senior author on the study, which found that CAD used with mammography did not improve the accuracy of diagnosis, and that its use may in fact result in missed cancers.

“The study by Lehman, et al., provides evidence that CAD yields no clear benefits in a large, diverse U.S. sample of women undergoing digital mammography,” Fenton wrote. “Thus we should question whether society should continue to pay for CAD use.”

Using data from the Breast Cancer Surveillance Consortium, Lehman’s observational study looked at 323,973 women undergoing digital screening mammography in diverse U.S. practices between 2003 and 2009. Mammograms were interpreted by 271 radiologists from 66 facilities. Tumor registry data identified 3,159 breast cancers within one year of screening.

For the study, the researchers analyzed the mammography performance, including its sensitivity (the proportion of cancers positively detected), specificity (the proportion of accurate negative findings), the number of cancers detected during mammography and those discovered within 12 months of a negative mammogram finding. They found that screening performance was not improved with CAD on any one of the assessed metrics. In fact, they found that sensitivity was significantly decreased for mammograms interpreted with CAD among radiologists who interpreted results with and without the added technology.

In the editorial, Fenton, who also has published several research articles about the merits of CAD, said any potential positive effects of CAD may be undetectable in the context of digital mammography, which may improve the radiologist’s interpretation regardless of CAD.

Since Medicare agreed to cover the cost of CAD in 2000, its use has surged to over 90 percent of U.S. mammograms. Lehman estimated that its prolific use adds up to more than $400 million per year, or $1 of every $10,000 spent on healthcare.

Miglioretti, who was senior author on the Lehman study and has a joint appointment as a senior investigator at Group Health Research Institute, said the results of the CAD research suggest that federal regulators and payers should base coverage determinations on facts.

“We need to make sure there is stronger evidence for new technologies before we start paying for them,” she said, “and before people are charged extra money for them.”

For more information: www.ucdmc.ucdavis.edu/cancer

Related Content

Study Examines Characteristics of Mobile Mammography Patients
News | Mammography | October 18, 2017
Significant differences were found among women receiving mammography at a cancer center versus those visiting a mobile...
Machine Learning Identifies Breast Lesions Likely to Become Cancer
News | Artificial Intelligence | October 18, 2017
A machine learning tool can help identify which high-risk breast lesions are likely to become cancerous, according to a...
Volpara Solutions to Showcase VolparaEnterprise Live! at RSNA
News | Mammography | October 16, 2017
Volpara Solutions will introduce VolparaEnterprise Live!, a mammography quality control tool, at the 2016 Radiological...
TMIST Mammography Study Opens Enrollment
News | Mammography | October 16, 2017
The Tomosynthesis Mammographic Imaging Screening Trial (TMIST), the first randomized trial to compare two types of...
National Breast Center Founder Names Top Three Innovations in Breast Cancer Treatment
News | Women's Health | October 11, 2017
In 2017, invasive breast cancer will be diagnosed in about 252,710 women and 2,470 men in the U.S. and remains the...
News | Brachytherapy Systems | October 05, 2017
External researchers presented new clinical data supporting the use of iCAD’s Xoft Axxent Electronic Brachytherapy (eBx...
Joint Venture Partnership Opening 16 New Breast Screening Sites in Texas
News | Breast Imaging | October 04, 2017
HCA Healthcare Gulf Coast Division and Solis Mammography have entered into a joint venture agreement to make breast...
International Trial Confirms Safety, Effectiveness of High-Dose Brachytherapy Plus Pelvic Radiation for Cervical Cancer
News | Brachytherapy Systems, Women's Healthcare | October 04, 2017
Findings from a new multicenter, international clinical trial confirm the effectiveness of high-dose brachytherapy or...
Kubtec Announces Expansion of 3-D Tomosynthesis Technology
News | Digital Radiography (DR) | October 04, 2017
October 4, 2017 — Kubtec announced at the annual conference of the American Association of Pathology Assistants (AAPA
The Siemens Acuson

The Siemens Acuson

Feature | Breast Imaging | October 04, 2017 | By Melinda Taschetta-Millane
According to a new Market Study Report,1 the automated breast ultrasound system (ABUS) market will see a 21 percent...
Overlay Init