Image-based breast cancer risk prediction is quickly becoming part of routine mammography workflows. Whether powered by AI or traditional quantitative methods, these models analyze mammogram features to surface patterns that may signal a higher likelihood of cancer.
For breast imaging teams, this represents an important step toward preventing late-stage diagnoses. But as adoption grows, a misconception has emerged: that image-based risk alone can stand in for a patient’s lifetime breast cancer risk. The issue isn’t that image-based risk lacks value — it’s that it answers a different and narrower clinical question.
Lifetime risk integrates family history, genetics, and clinical factors that indicate a patient’s underlying susceptibility to cancer — and it drives guideline-driven action immediately. Lifetime risk determines MRI eligibility, prompts genetics referral, and shapes screening frequency.
Image-based risk, on the other hand, reflects what the breast looks like today and the probability of cancer developing in the near term. It’s actionable information, but it captures only one dimension of a patient’s risk. Without lifetime risk alongside it, image-based scores can be over- or under-interpreted — leading to inconsistent escalation decisions and missed high-risk patients.
What Image-Based Risk Is Designed to Do
Image-based models assess mammographic characteristics to estimate short-term risk, often within a three- to five-year window. In breast imaging, this helps teams better differentiate patients within a screening population who may warrant closer attention or follow-up.
Used appropriately, image-based risk supports earlier identification and sharper near-term stratification. What it does not do is capture the inherited and longitudinal factors that drive lifetime risk, meaning some patients may not receive the referral to genetics or more frequent screenings that could prevent a diagnosis.
Why Lifetime Risk Requires More Than Imaging
Lifetime breast cancer risk is heavily influenced by family history and genetics — drivers that may not manifest on imaging for years, particularly in younger patients or those earlier in their screening journey.
When imaging findings begin to inform escalation, genetics referral, or high-risk surveillance decisions, missing this context can lead to incomplete evaluation of risk.
“What we hear from breast imaging teams is that image-based risk is valuable, but it can’t stand alone,” said Feyi Ayodele, CEO and co-founder of CancerIQ. “Radiologists want risk information that fits into a longitudinal framework — one that incorporates family history and genetics — so imaging findings translate into durable, guideline-aligned decisions.”
Once patients are identified as higher risk (in the long- or near-term), CancerIQ supports the next step as well — helping them understand their results and navigate genetics, MRI, or earlier follow-ups without adding work for imaging staff.
The Bottom Line for Imaging Leaders
Image-based risk represents a meaningful advance in mammography and cancer prevention, but it works best when interpreted alongside family history. For breast imaging programs, this balance is what turns risk signals into confident, consistent clinical action.
Image-based risk is only one piece of the prevention puzzle. See how CancerIQ helps imaging teams layer family history and genetics into a unified risk model in existing workflows. Learn how to bring lifetime risk into your imaging workflow.