The future of population-based breast cancer screening is likely personalized strategies based on clinically relevant risk models. Mammography-based risk models should remain robust to domain shifts caused by different populations and mammographic devices. Modern risk models do not ensure adaptation across vendor-domains and are often conflated to unintentionally rely on both precursors of cancer and systemic/global mammographic information associated with short- and long-term risk, respectively, which might limit performance. We developed a robust, cross-vendor model for long-term risk assessment. An augmentation-based domain adaption technique, based on flavorization of mammographic views, ensured generalization to an unseen vendor-domain. We trained on samples without diagnosed/potential malignant findings to learn systemic/global breast tissue features, called mammographic texture, indicative of future breast cancer. However, training so may cause erratic convergence. By excluding noise-inducing samples and designing a case-control dataset, a robust ensemble texture model was trained. This model was validated in two independent datasets. In 66,607 Danish women with flavorized Siemens views, the AUC was 0.71 and 0.65 for prediction of interval cancers within two years (ICs) and from two years after screening (LTCs), respectively. In a combination with established risk factors, the model's AUC increased to 0.68 for LTCs. In 25,706 Dutch women with Hologic-processed views, the AUCs were not different from the AUCs in Danish women with flavorized views. The results suggested that the model robustly estimated long-term risk while adapting to an unseen processed vendor-domain. The model identified 8.1% of Danish women accounting for 20.9% of ICs and 14.2% of LTCs.
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