The MAMA-MIA Challenge: Advancing Generalizability and Fairness in Breast MRI Tumor Segmentation and Treatment Response Prediction

Breast cancer is the most frequently diagnosed malignancy among women worldwide and a leading cause of cancer-related mortality. Dynamic contrast-enhanced magnetic resonance imaging plays a central role in tumor characterization and treatment monitoring, particularly in patients receiving neoadjuvant chemotherapy. However, existing artificial intelligence models for breast magnetic resonance imaging are often developed using single-center data and evaluated using aggregate performance metrics, limiting their generalizability and obscuring potential performance disparities across demographic subgroups. The MAMA-MIA Challenge was designed to address these limitations by introducing a large-scale benchmark that jointly evaluates primary tumor segmentation and prediction of pathologic complete response using pre-treatment magnetic resonance imaging only. The training cohort comprised 1,506 patients from multiple institutions in the United States, while evaluation was conducted on an external test set of 574 patients from three independent European centers to assess cross-continental and cross-institutional generalization. A unified scoring framework combined predictive performance with subgroup consistency across age, menopausal status, and breast density. Twenty-six international teams participated in the final evaluation phase. Results demonstrate substantial performance variability under external testing and reveal trade-offs between overall accuracy and subgroup fairness. The challenge provides standardized datasets, evaluation protocols, and public resources to promote the development of robust and equitable artificial intelligence systems for breast cancer imaging.

The Missing Piece: A Case for Pre-Training in 3D Medical Object Detection

Large-scale pre-training holds the promise to advance 3D medical object detection, a crucial component of accurate computer-aided diagnosis. Yet, it remains underexplored compared to segmentation, where pre-training has already demonstrated significant benefits. Existing pre-training approaches for 3D object detection rely on 2D medical data or natural image pre-training, failing to fully leverage 3D volumetric information. In this work, we present the first systematic study of how existing pre-training methods can be integrated into state-of-the-art detection architectures, covering both CNNs and Transformers. Our results show that pre-training consistently improves detection performance across various tasks and datasets. Notably, reconstruction-based self-supervised pre-training outperforms supervised pre-training, while contrastive pre-training provides no clear benefit for 3D medical object detection. Our code is publicly available at: https://github.com/MIC-DKFZ/nnDetection-finetuning.