Trustworthy Privacy-Preserving Multimodal Federated Learning for Personalised Breast Cancer Prediction

Survival analysis is central to clinical decision-making, yet reliable time-to-event models require large, diverse cohorts that are rarely available at a single institution, while privacy regulations restrict the centralization of patient data. Federated learning (FL) offers a privacy-preserving alternative by training shared models without exchanging raw data, but its effectiveness for survival modeling under realistic, heterogeneous conditions remains insufficiently understood. This paper presents a systematic, multi-model evaluation of federated survival analysis on a cross-institutional breast cancer cohort with naturally heterogeneous distributed clients. Three representative survival models, the Cox Proportional Hazards model, DeepSurv, and Random Survival Forest (RSF), are compared across centralized, local, and federated training, and three federated optimization strategies (FedAvg, FedProx, and FedAdam) are assessed for the gradient-based models. Results show that FL consistently outperforms local training and approaches, and occasionally exceeds, centralized performance, while RSF offers the best overall balance of discrimination, calibration, and robustness across heterogeneous clients. We further find that performance depends on the diversity of client distributions, and that FedAvg and FedProx are stronger and more stable than FedAdam. Based on these findings, we derive practical, decision-oriented guidelines mapping data, privacy, interpretability, and resource constraints to recommended model and training-paradigm choices for federated survival modeling in healthcare.

Privacy-sensitive and distributed characteristics of multi-center medical data bring severe obstacles to centralized modeling for accurate early prediction of sepsis. Federated learning (FL) has attracted growing attention as a promising framework for collaborative model development, as it allows multiple institutions to jointly train predictive models without directly sharing or centralizing raw data. Nevertheless, its practical performance, robustness, and privacy-preserving benefits remain insufficiently evaluated using real-world clinical datasets. To bridge this gap, this study systematically examines the application of federated learning to multi-center sepsis prediction. The experimental dataset consists of 648 clinically screened samples collected from three tertiary hospitals in China, with rigorous inclusion and exclusion criteria. We establish a centralized training paradigm as the performance baseline, and then implement a horizontal federated learning framework for distributed collaborative modeling. Extensive experimental results demonstrate that the federated learning-based model achieves highly comparable prediction accuracy to the centralized counterpart, while fundamentally avoiding privacy leakage. Further privacy security analysis verifies that malicious attackers cannot reconstruct the original patient data from the transmitted model parameters, indicating strong resistance against data reconstruction attacks. This work not only validates the practicality and security of federated learning in clinical sepsis prediction, but also provides a reliable and feasible solution for privacy-preserving multi-center medical collaboration.

Federated Learning (FL) enables collaborative model training across distributed healthcare institutions without centralising sensitive patient data. However, real-world healthcare federations are often characterised not only by non-IID data, but also by heterogeneous clinical objectives and partially overlapping feature spaces. Different hospitals may optimise distinct and potentially conflicting objectives, such as mortality risk prediction, readmission reduction, or length-of-stay estimation, while also retaining institution-specific clinical features that cannot be shared with other participants. Existing personalised FL methods mainly address statistical heterogeneity, whereas multi-objective FL approaches typically learn a shared global model without explicit client-level adaptation. To address these limitations, we propose \textbf{FedCARE}, a multi-objective personalised FL framework for smart healthcare services. FedCARE follows a two-stage training strategy. First, it learns a shared global backbone from common clinical features using Pareto-driven multi-objective federated optimisation. Second, each client independently fine-tunes the shared backbone using its private features and local clinical objectives, enabling institution-specific personalisation without additional communication overhead. We implement FedCARE in a cloud-based client-server federated deployment on the Melbourne Research Cloud and evaluate it on two real-world healthcare datasets, MIMIC-III and Diabetes 130-US Hospitals. Experimental results show that FedCARE consistently outperforms standard FL, multi-objective FL, and personalised FL baselines, achieving up to 12.5% AUROC improvement and 32.0% MAE reduction over FedAvg.