Examination of fully automated mammographic density measures using LIBRA and breast cancer risk in a cohort of 21,000 non-Hispanic white women

BACKGROUND: Breast density is strongly associated with breast cancer risk. Fully automated quantitative density assessment methods have recently been developed that could facilitate large-scale studies, although data on associations with long-term breast cancer risk are limited. We examined LIBRA assessments and breast cancer risk and compared results to prior assessments using Cumulus, an established computer-assisted method requiring manual thresholding. METHODS: We conducted a cohort study among 21,150 non-Hispanic white female participants of the Research Program in Genes, Environment and Health of Kaiser Permanente Northern California who were 40-74 years at enrollment, followed for up to 10 years, and had archived processed screening mammograms acquired on Hologic or General Electric full-field digital mammography (FFDM) machines and prior Cumulus density assessments available for analysis. Dense area (DA), non-dense area (NDA), and percent density (PD) were assessed using LIBRA software. Cox regression was used to estimate hazard ratios (HRs) for breast cancer associated with DA, NDA and PD modeled continuously in standard deviation (SD) increments, adjusting for age, mammogram year, body mass index, parity, first-degree family history of breast cancer, and menopausal hormone use. We also examined differences by machine type and breast view. RESULTS: The adjusted HRs for breast cancer associated with each SD increment of DA, NDA and PD were 1.36 (95% confidence interval, 1.18-1.57), 0.85 (0.77-0.93) and 1.44 (1.26-1.66) for LIBRA and 1.44 (1.33-1.55), 0.81 (0.74-0.89) and 1.54 (1.34-1.77) for Cumulus, respectively. LIBRA results were generally similar by machine type and breast view, although associations were strongest for Hologic machines and mediolateral oblique views. Results were also similar during the first 2 years, 2-5 years and 5-10 years after the baseline mammogram. CONCLUSION: Associations with breast cancer risk were generally similar for LIBRA and Cumulus density measures and were sustained for up to 10 years. These findings support the suitability of fully automated LIBRA assessments on processed FFDM images for large-scale research on breast density and cancer risk

External validation of a mammography-derived AI-based risk model in a U.S. breast cancer screening cohort of White and Black women

Despite the demonstrated potential of artificial intelligence (AI) in breast cancer risk assessment for personalizing screening recommendations, further validation is required regarding AI model bias and generalizability. We performed external validation on a U.S. screening cohort of a mammography-derived AI breast cancer risk model originally developed for European screening cohorts. We retrospectively identified 176 breast cancers with exams 3 months to 2 years prior to cancer diagnosis and a random sample of 4963 controls from women with at least one-year negative follow-up. A risk score for each woman was calculated via the AI risk model. Age-adjusted areas under the ROC curves (AUCs) were estimated for the entire cohort and separately for White and Black women. The Gail 5-year risk model was also evaluated for comparison. The overall AUC was 0.68 (95% CIs 0.64-0.72) for all women, 0.67 (0.61-0.72) for White women, and 0.70 (0.65-0.76) for Black women. The AI risk model significantly outperformed the Gail risk model for all wome

GaNDLF: A Generally Nuanced Deep Learning Framework for Scalable End-to-End Clinical Workflows in Medical Imaging

Deep Learning (DL) has greatly highlighted the potential impact of optimized machine learning in both the scientific and clinical communities. The advent of open-source DL libraries from major industrial entities, such as TensorFlow (Google), PyTorch (Facebook), and MXNet (Apache), further contributes to DL promises on the democratization of computational analytics. However, increased technical and specialized background is required to develop DL algorithms, and the variability of implementation details hinders their reproducibility. Towards lowering the barrier and making the mechanism of DL development, training, and inference more stable, reproducible, and scalable, without requiring an extensive technical background, this manuscript proposes the Generally Nuanced Deep Learning Framework (GaNDLF). With built-in support for k-fold cross-validation, data augmentation, multiple modalities and output classes, and multi-GPU training, as well as the ability to work with both radiographic and histologic imaging, GaNDLF aims to provide an end-to-end solution for all DL-related tasks, to tackle problems in medical imaging and provide a robust application framework for deployment in clinical workflows

Personalized early detection and prevention of breast cancer: ENVISION consensus statement

Abstract: The European Collaborative on Personalized Early Detection and Prevention of Breast Cancer (ENVISION) brings together several international research consortia working on different aspects of the personalized early detection and prevention of breast cancer. In a consensus conference held in 2019, the members of this network identified research areas requiring development to enable evidence-based personalized interventions that might improve the benefits and reduce the harms of existing breast cancer screening and prevention programmes. The priority areas identified were: 1) breast cancer subtype-specific risk assessment tools applicable to women of all ancestries; 2) intermediate surrogate markers of response to preventive measures; 3) novel non-surgical preventive measures to reduce the incidence of breast cancer of poor prognosis; and 4) hybrid effectiveness–implementation research combined with modelling studies to evaluate the long-term population outcomes of risk-based early detection strategies. The implementation of such programmes would require health-care systems to be open to learning and adapting, the engagement of a diverse range of stakeholders and tailoring to societal norms and values, while also addressing the ethical and legal issues. In this Consensus Statement, we discuss the current state of breast cancer risk prediction, risk-stratified prevention and early detection strategies, and their implementation. Throughout, we highlight priorities for advancing each of these areas

Toward novel noninvasive and low-cost markers for predicting strokes in asymptomatic carotid atherosclerosis: The role of ultrasound image analysis

Stroke is a serious and frequent cerebrovascular disease with an enormous socioeconomic burden worldwide. Stroke prevention includes treatment of carotid atherosclerosis, the most common underlying cause of stroke, according to a specific diagnostic algorithm. However, this diagnostic algorithm has proved insufficient for a large number of mostly asymptomatic subjects, which poses a significant research challenge of identifying novel personalized risk markers for the disease. This paper illustrates the potential of carotid ultrasound image analysis toward this direction, with ultrasound imaging being a low-cost and noninvasive imaging modality and ultrasound-image-based features revealing valuable information on plaque composition and stability. A concise report of state-of-the-art studies in the field is provided and a perspective for clinical scenario for optimal management of atherosclerotic patients is described. Challenges and necessary future steps toward the realization of this scenario are discussed in an attempt to urge and orient future research, and mainly include systematic applications to sufficiently large patient samples, appropriately designed longitudinal studies, confirmation with histological results, and clinical trials. © 2013 IEEE