This story provides readers with a balanced discussion of the potential downside of incorporating newer technologies into routine practice too soon. Specifically, the story reports evidence recently published in the New England Journal of Medicine that computer-aided detection (CAD), a newer method of reading mammographies, was no better–and may have produced more false positives–than images read and interpreted by radiologists alone. There was 20% increase in biopsies after mammographers used the CAD software, and many of these women had non-malignant lesions.
The article did not adequately describe the study. It was an observational study of select practices in the US – not randomized, not controlled and there was no information about how representative these samples were, especially in the centers that used CAD. The story reported on key results, but without adequately explaining how they were arrived at.
The story provides multiple perspectives on the CAD technology in breast cancer detection. The reporter interviews not only the lead author of the NEJM study, but also the author of an accompanying editorial on this newer technology, as well as radiologists who talk about CAD in their practice. Interviews with clinicians who offer a rationale for not using the CAD technology give excellent balance to the story and provide an often overlooked perspective: newer and more high-tech devices are not necessarily better.
The story notes the additional $20 per mammogram cost to Medicare with CAD. With the newer technology, costs to public health would increase via additional screening and unnecessary biopsies, and treatment would likely increase for cancers that may never become problematic (i.e. some forms of DCIS or ductal carcinoma in situ).
Importantly, the story discuses the continued benefit of mammography for early detection of breast cancer. The story highlights that computer-assisted screening does not replace human judgment in interpretation of radiological films. More screening centers with the CAD technology are available; however, the new technology may not serve women any better. Traditional mammography with a radiologist interpreting the results may be more accurate and result in fewer unnecessary tests and biopsies.
The story notes the an additional $20 per mammogram with CAD when billed to Medicare. With the newer technology, costs to public health would increase via additional screening and unnecessary biopsies, and treatment would increase for cancers that may never become problematic (i.e. some forms of DCIS or ductal carcinoma in situ).
The story provides data that there was little positive difference between radiologists' and CAD detection of cancer via mammogram images. However, the story does not mention results of any other evaluations of the technology (e.g. how it has been used in UK and other countries where results did show benefit in terms of increased detection of cancer).
The story mentions that the newer technology may result in over treatment as there are more false positives with the CAD technology vs. radiologists' analysis alone. In a recent study published in the New England Journal of Medicine, there was 20% increase in biopsy rates after mammographers used the CAD software.
The article does not present the study well. It was an observational study of select practices in the US – not randomized, not controlled and there was no information about how representative these samples were, especially the centers that used CAD. The story presented some key results but virtually nothing about the study design.
The story does not engage in disease mongering or suggest that women should opt for mammograms at centers that have the new CAD technology.
The story provides many clinical perspectives on the CAD technology. The reporter interviews not only the study author and the author of an accompanying NEJM editorial, but also clinicians and radiologists who talk about use of CAD in practice. Interviews with clinicians who provide their rationale for not using the CAD technology provide excellent balance to the story.
The story discusses the continued benefit of mammography for early detection of breast cancer. The story highlights that computer-assisted screening does not replace human judgment in interpretation of radiological films.
The story mentions that about 30% of mammography centers use computer-aided detection (CAD) technology.
The story mentions that CAD is a newer method of reading mammographies, but in a recent observational trial it was no better–and may have produced more false positives–than images read and interpreted by radiologists alone.
The story does not rely solely on a press release for information, and there is independent reporting and sources cited not affiliated with the recently published data on CAD.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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