title: An integrated breast cancer risk assessment and management model based on fuzzy cognitive maps.
abstract: BACKGROUND
  There is a growing demand for women to be classified into different risk groups of developing breast cancer (BC). The focus of the reported work is on the development of an integrated risk prediction model using a two-level fuzzy cognitive map (FCM) model. The proposed model combines the results of the initial screening mammogram of the given woman with her demographic risk factors to predict the post-screening risk of developing BC.
  
  
  METHODS
  The level-1 FCM models the demographic risk profile. A nonlinear Hebbian learning algorithm is used to train this model and thus to help on predicting the BC risk grade based on demographic risk factors identified by domain experts. The risk grades estimated by the proposed model are validated using two standard BC risk assessment models viz. Gail and Tyrer-Cuzick. The level-2 FCM models the features of the screening mammogram concerning normal, benign and malignant cases. The data driven Hebbian learning algorithm (DDNHL) is used to train this model in order to predict the BC risk grade based on these mammographic image features. An overall risk grade is calculated by combining the outcomes of these two FCMs.
  
  
  RESULTS
  The main limitation of the Gail model of underestimating the risk level of women with strong family history is overcome by the proposed model. IBIS is a hard computing tool based on the Tyrer-Cuzick model that is comprehensive enough in covering a wide range of demographic risk factors including family history, but it generates results in terms of numeric risk score based on predefined formulae. Thus the outcome is difficult to interpret by naive users. Besides these models are based only on the demographic details and do not take into account the findings of the screening mammogram. The proposed integrated model overcomes the above described limitations of the existing models and predicts the risk level in terms of qualitative grades. The predictions of the proposed NHL-FCM model comply with the Tyrer-Cuzick model for 36 out of 40 patient cases. With respect to tumor grading, the overall classification accuracy of DDNHL-FCM using 70 real mammogram screening images is 94.3%. The testing accuracy of the proposed model using 10-fold cross validation technique outperforms other standard machine learning based inference engines.
  
  
  CONCLUSIONS
  In the perspective of clinical oncologists, this is a comprehensive front-end medical decision support system that assists them in efficiently assessing the expected post-screening BC risk level of the given individual and hence prescribing individualized preventive interventions and more intensive surveillance for high risk women.
authors.affiliation: Computer Science Engineering, RVS College of Engineering and Technology, Coimbatore, India. Electronic address: jayashreecls@gmail.com.
authors.forename: Jayashree
authors.initials: J
authors.lastname: Subramanian
authors.affiliation: Mechatronics Engineering, Kumaraguru College of Technology, Coimbatore, India. Electronic address: skylabm@gmail.com.
authors.forename: Akila
authors.initials: A
authors.lastname: Karmegam
authors.affiliation: Computer Engineering Department, Technological Educational Institute of Central Greece, 3rd KM Old National Road Lamia-Athens, 35100 Lamia, Greece. Electronic address: epapageorgiou@teiste.gr.
authors.forename: Elpiniki
authors.initials: E
authors.lastname: Papageorgiou
authors.affiliation: Diagnostic Medical Center "Diagnostiko Iatriki A.E.", Larisa, Greece. Electronic address: nikpapandr@gmail.com.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papandrianos
authors.affiliation: Electronics and Communication Engineering, Kumaraguru College of Technology, Coimbatore, India. Electronic address: vasuki.a.ece@kct.ac.in.
authors.forename: A
authors.initials: A
authors.lastname: Vasukie
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D019295:Computational Biology; D003198:Computer Simulation; D003661:Decision Support Techniques; D005104:Expert Testimony; D005260:Female; D017143:Fuzzy Logic; D006801:Humans; D008327:Mammography; D015233:Models, Statistical; D060787:Neoplasm Grading; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012307:Risk Factors; D012308:Risk Management / Q000706:statistics & numerical data*
keywords: Breast cancer; Fuzzy cognitive maps; Hebbian learning; Mammogram screening; Medical decision support systems; Risk assessment