Utilization of Computer-Aided Detection for Digital Screening Mammography in the United States, 2008 to 2016

Computer-aided detection (CAD) for screening mammography is a software technology designed to improve radiologists' reading performance. Since 2007, multiple Breast Cancer Surveillance Consortium research papers have shown that CAD decreases performance by increasing recalls and decreasing the detection of invasive cancer while increasing the detection of ductal carcinoma in situ. The aim of this study was to test the hypothesis that CAD use by digital mammography facilities would decrease over time.

In August 2007, August 2011, and March 2016, the FDA database of certified mammography facilities was accessed, and a random sample of 400 of approximately 8,500 total facilities was generated. In 2008 and 2011, a telephone survey was conducted of the facilities regarding digital mammography and CAD use. In 2016, facility websites were reviewed before calling the facilities. Bonferroni-corrected P values were used to assess statistical differences in the proportion of CAD at digital facilities for the three surveys.

The mean proportion of digital facilities using CAD was 91.4%, including 91.4% (128 of 140) in 2008, 90.2% (238 of 264) in 2011, and 92.3% (358 of 388) in 2016. The difference for 2008 versus 2011 was 1.3% (95% confidence interval [CI], -0.5% to 7.7%), for 2011 versus 2016 was -2.1% (95% CI, -6.9% to 2.7%), and for 2008 versus 2016 was -0.8% (95% CI, -6.7% to 5.0%).

In three national surveys, it was found that CAD use at US digital screening mammography facilities was stable from 2008 to 2016. This persistent utilization is relevant to the debate on the value of targeting ductal carcinoma in situ in screening.