BreastMammo and DenseMammo: Benchmarks for Mammography Domain Generalization

Deep learning-based computer-aided diagnosis (CAD) systems have shown strong performance in breast cancer diagnosis, particularly for classification tasks in mammography. However, domain shifts across multi-site datasets remain a challenge, especially when models are applied to unseen domains. In this work, we proposed a calcification classification framework to improve malignant versus benign breast disease classification across multi-site mammography datasets. The framework consisted of two components: (1) an unsupervised domain adaptation module based on style transfer models (AdaIN and CycleGAN) to generate vendor-specific and technique-specific training samples without additional annotations, and (2) a supervised classification module using Swin Transformer V2 as the backbone. We evaluated the proposed method on three datasets: cross-validation on OPTIMAM (National Health Service, United Kingdom; n=2994), followed by external validation on EMBED (Emory University; n=125), and Duke Calcification Dataset v1 (n=788). These datasets cover multiple vendors and include both full-field digital mammography and synthetic 2D images derived from digital breast tomosynthesis. The proposed framework improved cross-site performance for both EMBED (AUC 0.68 to 0.72) and the Duke Calcification Dataset (AUC 0.68 to 0.73). These findings indicate that domain adaptation can reduce domain shifts and improve the generalization for calcification classification across multi-site datasets.

Foundation models are increasingly used as image feature extractors for mammography, but their robustness under external domain shift remains unclear. We benchmark 15 foundation-model backbones across breast density, BI-RADS severity, and cancer status using a unified frozen-backbone linear-probe protocol, training on 3 source datasets and evaluating on 12 task-compatible out-of-distribution (OOD) datasets after label harmonization. Mammography-specific vision-language models (Mammo-FM and MaMA) provide the strongest mean OOD performance, but robustness is not explained by mammography exposure alone. DINOv3 remains a competitive vision-only baseline, and mammography-adapted pretraining does not consistently improve generalization. Dataset-level analysis further shows that even leading models show heterogeneous performance across datasets. Feature-space inspection reveals that useful representations can preserve clinical signal while retaining dataset and acquisition structure. These findings highlight dataset-level OOD evaluation as a central criterion for assessing mammography representations. Our code is publicly available: https://github.com/biomedia-mira/mammo-ood.

Enhancing classification performance in mammography remains a persistent challenge across both small curated datasets and large-scale clinical cohorts. Conventional transfer learning approaches often neglect dataset-specific characteristics, while recent neighborhood-informed methods have been restricted to narrow tasks with rigid formulations, limiting their scalability to population-level datasets. To address these challenges, we propose the Dataset-Informed Transfer Learning (DITL) framework, which integrates dataset-derived difficulty signals with neighborhood-based triplet supervision in a unified objective. DITL introduces two adaptive components: (i) Adaptive Difficulty-Weighted Cross-Entropy (A-DWCE), which assigns per-sample weights based on k-nearest neighbor label purity in a self-supervised feature space, and (ii) Adaptive Neighborhood Representation Triplet (A-NR-Triplet), which enforces intra-class compactness and inter-class separation using a learnable margin. Unlike focal loss, DITL requires no hyperparameter tuning, removes heuristic weighting and fixed margins, and incurs negligible computational overhead, yielding a robust and scalable optimization strategy. On the large-scale VinDR-Mammo dataset, DITL achieves state-of-the-art performance for whole-image breast density classification, with significant improvements across accuracy, F1-score, and AUC (p < 0.0001). Beyond large cohorts, DITL also delivers consistent, statistically significant gains on small ROI datasets (p < 0.0001). By bridging small-scale lesion analysis with large-scale density estimation, DITL establishes a clinically relevant, scalable, and generalizable framework for mammography classification, spanning the full breast cancer screening-to-diagnosis spectrum.