Modeling the effect of computer-aided detection on the sensitivity of screening mammography

We have developed a Monte Carlo model to examine the cancer detection rate in screening mammography. We simulated the situation where screening was implemented for 9 years and then CADe was implemented for an additional 9 years. We investigated the effectiveness of two different methods for measuring changes in cancer detection rate. The first method was a sequential method in which the radiologist first reads without CADe and then immediately reads with CADe. The second method is temporal comparison where the cancer detection rates for two periods of time are compared: one without the use of CADe and one when CADe is in use. The model predictions have important implications for clinical studies of CADe. The temporal method is unlikely to measure a real affect, because the effect is small. A sequential method can measure an increase in the number of cancers detected because of CADe, but it cannot measure an overall increase in the cancer detection rate of the screening program.