FairSAM: Fair Classification on Corrupted Image Data Through Sharpness-Aware Minimization

Labeled datasets reflect the biases of their annotation pipelines, which sometimes introduce label bias: group-conditional label errors that cause systematic performance disparities across demographic subgroups. Label bias in image segmentation remains underexplored, as even detecting it typically requires clean, unbiased annotations, which are not readily available. We present a data-centric adaptation of Confident Learning to segmentation, allowing detection of label bias directly in the training data without a clean, unbiased ground truth. By comparing the provided training labels to the model's confident predictions, we isolate directional errors that quantify the presence and nature of bias, where standard overlap metrics like Dice fail. We further show that label bias influences subgroup separability in the encoder's feature space, an artifact we leverage for bias mitigation rather than suppressing it. We evaluate three datasets, spanning from synthetic to real-life bias, showing how our framework reliably detects and mitigates bias without access to clean labels, achieving equitable performance across experimental conditions.

Medical image segmentation models can perform unevenly across subgroups. Most existing fairness methods focus on improving average subgroup performance, implicitly treating each subgroup as internally homogeneous. However, this can hide difficult cases within a subgroup, where high-loss samples are obscured by the subgroup mean. We call this problem \textbf{intra-group hidden failure}. To solve this, we propose \textbf{DuetFair} mechanism, a dual-axis fairness framework that jointly considers inter-subgroup adaptation and intra-subgroup robustness. Based on DuetFair, we introduce \textbf{FairDRO}, which combines distribution-aware mixture-of-experts (dMoE) with subgroup-conditioned distributionally robust optimization (DRO) loss aggregation. This design allows the model to adapt across subgroups while also reducing hidden failures within each subgroup. We evaluate FairDRO on three medical image segmentation benchmarks with varying degrees of within-group heterogeneity. FairDRO achieves the best equity-scaled performance on Harvard-FairSeg and improves worst-case subgroup performance on HAM10000 under both age- and race-based grouping schemes. On the 3D radiotherapy target cohort, FairDRO further improves worst-group Dice by 3.5 points ($\uparrow 6.0\%$) under the tumor-stage grouping and by 4.1 points ($\uparrow 7.4\%$) under the institution grouping over the strongest baseline.

The notion of algorithmic fairness has been actively explored from various aspects of fairness, such as counterfactual fairness (CF) and group fairness (GF). However, the exact relationship between CF and GF remains to be unclear, especially in image classification tasks; the reason is because we often cannot collect counterfactual samples regarding a sensitive attribute, essential for evaluating CF, from the existing images (\eg, a photo of the same person but with different secondary sex characteristics). In this paper, we construct new image datasets for evaluating CF by using a high-quality image editing method and carefully labeling with human annotators. Our datasets, \oursceleb and \ourslfw, build upon the popular image GF benchmarks; hence, we can evaluate CF and GF simultaneously. We empirically observe that CF does not imply GF in image classification, whereas previous studies on tabular datasets observed the opposite. We theoretically show that it could be due to the existence of a latent attribute $G$ that is correlated with, but not caused by, the sensitive attribute (\eg, secondary sex characteristics are highly correlated with hair length). From this observation, we propose a simple baseline, Counterfactual Knowledge Distillation (CKD), to mitigate such correlation with the sensitive attributes. Extensive experimental results on \oursceleb and \ourslfw demonstrate that CF-achieving models satisfy GF if we successfully reduce the reliance on $G$ (\eg, using CKD).