Enhancing Breast Density Assessment in Mammograms Through Artificial Intelligence.

Breast cancer is the leading cause of cancer-related deaths among women worldwide. Early detection through mammography significantly improves outcomes, with breast density acting as both a risk factor and a key interpretive feature. Although the Breast Imaging Reporting and Data System (BI-RADS) provides standardized density categories, assessments are often subjective and variable. While automated tools exist, most are proprietary and resource-intensive, limiting their use in underserved settings. There is a critical need for accessible, low-cost AI solutions that provide consistent breast density classification. This study aims to develop and evaluate an open-source, computer vision-based approach using deep learning techniques for objective breast density assessment in mammography images, with a focus on accessibility, consistency, and applicability in resource-limited healthcare environments. Our approach integrates a custom-designed convolutional neural network (CD-CNN) with an extreme learning machine (ELM) layer for image-based breast density classification. The retrospective dataset includes 10,371 full-field digital mammography images, previously categorized by radiologists into one of four BI-RADS breast density categories (A-D). The proposed model achieved a testing accuracy of 95.4%, with a specificity of 98.0% and a sensitivity of 92.5%. Agreement between the automated breast density classification and the specialists' consensus was strong, with a weighted kappa of 0.90 (95% CI: 0.82-0.98). On the external and independent mini-MIAS dataset, the model achieved an accuracy of 73.9%, a precision of 81.1%, a specificity of 87.3%, and a sensitivity of 75.1%, which is comparable to the performance reported in previous studies using this dataset. The proposed approach advances breast density assessment in mammograms, enhancing accuracy and consistency to support early breast cancer detection.