Abstract
BACKGROUND: Image-derived artificial intelligence (AI) risk models have shown promise in identifying high-risk women in the short term. The long-term performance of image-derived risk models expanded with clinical factors has not been investigated. METHODS: We performed a case-cohort study of 8110 women aged 40-74 randomly selected from a Swedish mammography screening cohort initiated in 2010 together with 1661 incident BCs diagnosed before January 2022. The imaging-only AI risk model extracted mammographic features and age at screening. Additional lifestyle/familial risk factors were incorporated into the lifestyle/familial-expanded AI model. Absolute risks were calculated using the two models and the clinical Tyrer-Cuzick v8 model. Age-adjusted model performances were compared across the 10-year follow-up. RESULTS: The AUCs of the lifestyle/familial-expanded AI risk model ranged from 0.75 (95%CI: 0.70-0.80) to 0.68 (95%CI: 0.66-0.69) 1-10 years after study entry. Corresponding AUCs were 0.72 (95%CI: 0.66-0.78) to 0.65 (95%CI: 0.63-0.66) for the imaging-only model and 0.62 (95%CI: 0.55-0.68) to 0.60 (95%CI: 0.58-0.61) for Tyrer-Cuzick v8. The increased performances were observed in multiple risk subgroups and cancer subtypes. Among the 5% of women at highest risk, the PPV was 5.8% using the lifestyle/familial-expanded model compared with 5.3% using the imaging-only model, p < 0.01, and 4.6% for Tyrer-Cuzick, p < 0.01. CONCLUSIONS: The lifestyle/familial-expanded AI risk model showed higher performance for both long-term and short-term risk assessment compared with imaging-only and Tyrer-Cuzick models.