The LongiMam model for improved breast cancer risk prediction using longitudinal mammograms
This work addresses the need for robust risk-adapted breast cancer screening models for clinical settings, though it appears incremental as it builds on existing deep learning approaches by incorporating more prior data.
The authors tackled the problem of breast cancer risk prediction by developing LongiMam, a deep learning model that integrates longitudinal mammograms, and found that it consistently improved prediction when prior mammograms were included, with enhanced performance in subgroups like women with dense breasts or those aged 55+.
Risk-adapted breast cancer screening requires robust models that leverage longitudinal imaging data. Most current deep learning models use single or limited prior mammograms and lack adaptation for real-world settings marked by imbalanced outcome distribution and heterogeneous follow-up. We developed LongiMam, an end-to-end deep learning model that integrates both current and up to four prior mammograms. LongiMam combines a convolutional and a recurrent neural network to capture spatial and temporal patterns predictive of breast cancer. The model was trained and evaluated using a large, population-based screening dataset with disproportionate case-to-control ratio typical of clinical screening. Across several scenarios that varied in the number and composition of prior exams, LongiMam consistently improved prediction when prior mammograms were included. The addition of prior and current visits outperformed single-visit models, while priors alone performed less well, highlighting the importance of combining historical and recent information. Subgroup analyses confirmed the model's efficacy across key risk groups, including women with dense breasts and those aged 55 years or older. Moreover, the model performed best in women with observed changes in mammographic density over time. These findings demonstrate that longitudinal modeling enhances breast cancer prediction and support the use of repeated mammograms to refine risk stratification in screening programs. LongiMam is publicly available as open-source software.