External validation of an AI-driven breast cancer risk prediction model in a racially diverse cohort of women undergoing mammographic screening

The aim of this retrospective case-cohort study was to perform additional validation of an artificial intelligence (AI)-driven breast cancer risk model in a racially diverse cohort of women undergoing screening. We included 176 breast cancer cases with non-actionable mammographic screening exams 3 months to 2 years prior to cancer diagnosis and a random sample of 4,963 controls from women with non-actionable mammographic screening exams and at least one-year of negative follow-up (Hospital University Pennsylvania, PA, USA; 9/1/2010-1/6/2015). A risk score for each woman was extracted from full-field digital mammography (FFDM) images via an AI risk prediction model, previously developed and validated in a Swedish screening cohort. The performance of the AI risk model was assessed via age-adjusted area under the ROC curve (AUC) for the entire cohort, as well as for the two largest racial subgroups (White and Black). The performance of the Gail 5-year risk model was also evaluated for comparison purposes. The AI risk model demonstrated an AUC for all women = 0.68 95% CIs [0.64, 0.72]; for White = 0.67 [0.61, 0.72]; for Black = 0.70 [0.65, 0.76]. The AI risk model significantly outperformed the Gail risk model for all women (AUC = 0.68 vs AUC = 0.55, p<0.01) and for Black women (AUC = 0.71 vs AUC = 0.48, p<0.01), but not for White women (AUC = 0.66 vs AUC = 0.61, p=0.38). Preliminary findings in an independent dataset suggest a promising performance of the AI risk prediction model in a racially diverse breast cancer screening cohort.