© 2004 by Oxford University Press
© 2004 Oxford University Press
CORRESPONDENCE |
RESPONSE: Re: Computer-Aided Detection of Breast Cancer: Has Promise Outstripped Performance?
Affiliations of authors: University of Washington, Seattle, WA (JGE); Dartmouth Medical School, Lebanon, NH (PAC).
Correspondence to: Joann G. Elmore, MD, MPH, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave., Box 359780, Seattle, WA 98104-2499 (e-mail: jelmore{at}u.washington.edu)
It is important to consider all possible explanations for research and clinical findings. We, therefore, agree with Gur et al., that the results they noted, which were obtained in just one academic setting, might be different had they been obtained in other academic and/or community settings.
However, their discussion of the possible benefits of computer-aided detection should be balanced with a discussion of possible harms of computer-aided detection. On the basis of their findings, one could hypothesize that the mammography recall rate is actually higher with the addition of computer-aided detection than without it. For example, Gur et al. (1) reported that "the percentage of women who were screened for the first time gradually decreased from approximately 40% in 2000 to 30% in the last quarter of 2002, whereas the percentage of women who had repeated screenings gradually increased." The recall rates for screening mammography examination performed on women who have had repeated examinations are approximately 5%, which is lower than the recall rates for screening examinations performed on women who have not had previous examinations (approximately 10%) because the prior films are often available for comparison (2,3). Although Gur et al. did not indicate the actual percentage of women with prior films available for comparison, we suspect that that percentage might have increased enough during this study period to result in a small reduction in the recall rate. The recall rate did not change in this study with the addition of computer-aided detection, despite the increased percentage of women with repeat exams, and this lack of change warrants further attention.
We applaud these authors for performing quality assessment of breast cancer screening as it is actually being practiced. This is often not an easy task.
REFERENCES
1 Gur D, Sumkin JH, Rockette HE, Ganott M, Hakim C, Hardesty L, et al. Changes in breast cancer detection and mammography recall rates after the introduction of a computer-aided detection system. J Natl Cancer Inst 2004;96:185–90.
2 Thurfjell MG, Vitak B, Azavedo E, Svane G, Thurfjell E. Effect on sensitivity and specificity of mammography screening with or without comparison of old mammograms. Acta Radiol 2000;41:52–6.[CrossRef][Medline]
3 Paquette D, Snider J, Bouchard F, Olivotto I, Bryant H, Decker K,et al. Performance of screening mammography in organized programs in Canada in 1996. CMAJ 2000;163: 1133–8.
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J Natl Cancer Inst 2004 96: 717-718.
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