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To review research on deep learning models and their potential application within breast screening. The greatest issue in breast screening is a workforce crisis across the UK, much of Europe and even Japan. Traditional computer-aided detection (CAD) for mammography decision-support could not reach the level of an independent reader. Deep learning (DL) outperforms CAD and is close to surpassing human performance. DL is already capable of decision support and density assessment for 2D full-field digital mammography (FFDM), and is on the cusp of providing consistent, accurate and interpretable mammography reading as an independent reader. A bold vision for the future of breast cancer screening is required if programmes are to maintain double reading standards. DL provides the potential for single reading programmes, such as in the USA, to reach EU double reading accuracy, as well as providing practical support for adoption of the emerging modality of digital breast tomosynthesis.

PURPOSE: To explore whether generative adversarial networks (GANs) can enable synthesis of realistic medical images that are indiscernible from real images, even by domain experts. MATERIALS AND METHODS: In this retrospective study, progressive growing GANs were used to synthesize mammograms at a resolution of 1280 × 1024 pixels by using images from 90 000 patients (average age, 56 years ± 9) collected between 2009 and 2019. To evaluate the results, a method to assess distributional alignment for ultra–high-dimensional pixel distributions was used, which was based on moment plots. This method was able to reveal potential sources of misalignment. A total of 117 volunteer participants (55 radiologists and 62 nonradiologists) took part in a study to assess the realism of synthetic images from GANs. RESULTS: A quantitative evaluation of distributional alignment shows 60%–78% mutual-information score between the real and synthetic image distributions, and 80%–91% overlap in their support, which are strong indications against mode collapse. It also reveals shape misalignment as the main difference between the two distributions. Obvious artifacts were found by an untrained observer in 13.6% and 6.4% of the synthetic mediolateral oblique and craniocaudal images, respectively. A reader study demonstrated that real and synthetic images are perceptually inseparable by the majority of participants, even by trained breast radiologists. Only one out of the 117 participants was able to reliably distinguish real from synthetic images, and this study discusses the cues they used to do so. CONCLUSION: On the basis of these findings, it appears possible to generate realistic synthetic full-field digital mammograms by using a progressive GAN architecture up to a resolution of 1280 × 1024 pixels. Supplemental material is available for this article. © RSNA, 2020

Traditional computer aided detection (CAD) systems for breast cancer screening relied on machine learning with human-coded feature-engineering. They have largely failed to fulfill the promise of improving screening accuracy and workflow efficiency, and are often associated with increased recall rates and avoidable screening costs due to high instances of false positive markings. Advances in machine learning (such as deep learning) are on the cusp of providing more effective, more efficient, and even more patient-centric breast cancer screening support than ever before. By leveraging the consistent high sensitivity and specificity performance of autonomous systems, in combination with expert human oversight, the potential for efficient single-reader software-supported screening programs with low recall rates is on the horizon.