Foundation model embeddings capture pre-diagnostic changes on screening mammograms

TL;DR - Foundation-model embeddings captured subtle longitudinal mammogram changes before cancer diagnosis without task-specific adaptation. The effect depended strongly on clinically grounded pretraining, suggesting embeddings could support earlier breast-cancer risk detection.

• The study analyzed 1,773 biopsied women and 1,773 matched controls, each with at least two annual screenings before the index exam.
• Malignant cases moved faster than controls along a data-derived “cancer direction” during the two preceding screening intervals in MedImageInsight’s embedding space.
• Mammo-CLIP and HOPPR showed narrower significant effects, while BiomedCLIP showed none.
• Results were broadly consistent across matched case-control and within-patient contralateral-breast comparisons.