Fundamental limitations in developing computer-aided detection for mammography

While asymptomatic screening with mammography has been proven to reduce breast cancer mortality, radiologists miss cancers when reading screening mammograms. Computer-aided detection (CADe) is being developed to help radiologists avoid overlooking a cancer. In this paper, we describe two overarching issues that limit the current development of CADe schemes. These are the inability to optimize a scheme for clinical impact - current methods only optimize for how well the CADe scheme works in the absence of a radiologist - and the lack of a figure of merit that quantifies the performance efficiency of the CADe scheme. Such a figure of merit could be used to determine how much better performance a CADe scheme could obtain, at least in theory, and which component of the several techniques employed in the CADe scheme is the weakest link. (c) 2010 Elsevier B.V. All rights reserved.