Towards Early Detection: AI-Based Five-Year Forecasting of Breast Cancer Risk Using Digital Breast Tomosynthesis Imaging

As early detection of breast cancer strongly favors successful therapeutic outcomes, there is major commercial interest in optimizing breast cancer screening. However, current risk prediction models achieve modest performance and do not incorporate digital breast tomosynthesis (DBT) imaging, which was FDA-approved for breast cancer screening in 2011. To address this unmet need, we present a deep learning (DL)-based framework capable of forecasting an individual patient's 5-year breast cancer risk directly from screening DBT. Using an unparalleled dataset of 161,753 DBT examinations from 50,590 patients, we trained a risk predictor based on features extracted using the Meta AI DINOv2 image encoder, combined with a cumulative hazard layer, to assess a patient's likelihood of developing breast cancer over five years. On a held-out test set, our best-performing model achieved an AUROC of 0.80 on predictions within 5 years. These findings reveal the high potential of DBT-based DL approaches to complement traditional risk assessment tools, and serve as a promising basis for additional investigation to validate and enhance our work.