• Joshua J Fenton, Guibo Xing, Joann G Elmore, Heejung Bang, Steven L Chen, Karen K Lindfors, and Laura-Mae Baldwin.
• University of California, Davis, Department of Family and Community Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817, USA. joshua.fenton@ucdmc.ucdavis.edu
• Ann. Intern. Med. 2013 Apr 16; 158 (8): 580-7.

BackgroundComputer-aided detection (CAD) has rapidly diffused into screening mammography practice despite limited and conflicting data on its clinical effect.ObjectiveTo 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.DesignRetrospective cohort study.SettingMedicare program.ParticipantsWomen 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).MeasurementsIncident 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.ResultsFrom 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]).LimitationShort follow-up for cancer stage, potential unmeasured confounding, and uncertain generalizability to younger women.ConclusionUse 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 SourceCenter for Healthcare Policy and Research, University of California, Davis.

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