Published 31 Oct 2023

Artificial Intelligence for Breast Cancer Detection in Mammography



The market for AI in mammography is expected to reach $2.8 billion by 2029, driven by an increasing prevalence of breast cancer, growing awareness of the importance of early detection, and the development of innovative AI-powered mammography tools. 
Given these dynamics, it is imperative to delve into how exactly AI contributes to advancements in breast cancer detection. 
By providing more accurate readings of mammograms, AI has exciting potential to lower mortality rates by enhancing early cancer detection rates. Furthermore, with the number of radiologists decreasing, AI in mammography can help ease workloads.
However, promising results from various studies and trials indicate a positive trajectory where AI could be crucial in combatting breast cancer, facilitating personalized and timely interventions.
To fully appreciate the potential impact of AI here, let us first examine some recent assessments.
Assessment from the European Commission Initiative on Breast Cancer 
As of 2023, breast cancer remains the most diagnosed cancer among women in the European Union (EU), with an estimated 380,000 cases, which constitute about 13.8% of all cancer diagnoses in the region.
The significance of this phenomenon is amplified by research on diagnostic methods. 
According to Expert Review of Molecular Diagnostics, numerous studies have shown that mammography screening contributes significantly to reducing mortality rates. 
Let us move forward to discuss how AI specifically impacts this diagnostic practice. 
Moreover, AI algorithms show promise in significantly reducing the reading time by as much as 50%, offering a vital resource-saving alternative when there is a shortage of radiologists. 
Not only does AI streamline diagnostic procedures, but it also enhances them.  
AI algorithms can provide objective, measurable results on variables like breast density, potentially leading to supplemental or additional screening methods that are more closely tailored to individual risks. 
This marks an evolution in personalization in healthcare and could permit more nuanced, stratified screening programs that allocate resources more effectively, ranging from shorter screening intervals for high-risk individuals to supplemental procedures like MRI or contrast-enhanced mammography. 
While these advances are promising, it is also crucial to compare them against traditional risk models to understand their true efficacy. 
Addressing Limitations of Traditional Risk Models for Early Detection  
Traditional risk assessment models such as the Gail and Tyrer-Cuzick models predict a 5-year, 10-year, or lifetime risk of breast cancer, considering lifestyle factors, family history, and even germline variants. 
Traditional models like the Breast Cancer Surveillance Consortium (BCSC) risk model have been integral in gauging the risk of breast cancer.  
While these traditional models have been valuable, they are not without limitations. 
A study published in the journal Radiology provides empirical evidence to argue that AI algorithms outperform the BCSC model in predicting the 5-year risk of breast cancer.  
AI is not merely an auxiliary tool; it has the potential to surpass current standards. 
The algorithms generated continuous scores based on the mammographic examinations and demonstrated a higher time-dependent AUC ranging from 0.63 to 0.67, indicating a statistically significant increase in the predictive power. 
Most importantly, the enhanced predictive power of these AI algorithms can be instrumental in early detection because they can identify subtler risk factors not captured by traditional models.  
By refining risk estimates, AI allows healthcare professionals to catch the signs of cancer in nascent stages when treatment is most effective. 
Having considered AI’s aptness in risk assessment, let’s turn our focus to its practical applications in both detecting and managing radiologist workloads.
Improved Cancer Detection and Reduced Workload
According to a study from Radiology: Artificial Intelligence, integrating AI into the breast cancer screening process holds a massive potential to impact breast cancer care positively. The research illustrates a notable enhancement in the consistency and accuracy of radiologists' breast cancer diagnoses when aided by AI without interruptions to workflow.  
One significant advantage such AI demonstrated is its potential to flag early-stage cancers or cases that radiologists might categorize as false negatives. In other words, AI can notice subtleties humans might miss (especially after long work hours, when diagnostic accuracy begins to diminish due to fatigue).  
The tool studied in this context also appears particularly effective in less complex cases, enabling radiologists to allocate their attention and resources to more critical patients.  
In virtue of this, we see the continued necessity of radiologists even in the wake of AI's implementation –AI is ineffective without radiologists using it, as well as sometimes being altogether inapplicable in more complex instances.  
Another study presented in the journal Radiology by RSNA delves into the significant contributions artificial intelligence (AI) can make to breast cancer screening. This study takes a different approach, focusing on its implications for the radiologists themselves. 
The study employs a retrospective simulation approach to assess the efficacy of an AI system in identifying mammograms of varying risk categories and their potential to reduce radiologist workload.  
The RSNA investigation engages with mammographic examination data from the Danish Capital Region breast cancer screening program.  
The AI tool assigns scores ranging from 0 to 10, representing malignancy risk, to each mammogram. Through simulation, routine mammograms—those scoring under 5—would be exempt from further radiologist evaluation, and those exceeding a specific recall threshold would be subject to recall. These results hold considerable significance, particularly for healthcare infrastructure. 
The study involved 114,421 screenings, revealing a slightly lower but statistically non-inferior sensitivity rate for AI-based screening (69.7%) compared to traditional radiologist-led screening (70.8%). This finding should not be underestimated, as it signals a crucial shift in healthcare practices. 
Significantly, the specificity of AI-based methods (98.6%) exceeded that of radiologist screenings (98.1%), indicating fewer false positives.  
Further, the workload for radiologists decreased by a substantial 62.6%, and 25.1% of false-positive screenings were avoided.
Integrating AI in mammography holds tremendous promise for improving breast cancer detection and management and easing the workloads of radiologists.
While AI’s full potential is yet to be realized, the current findings are encouraging, signalling a shift in how we approach breast cancer screening and treatment.

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