# Benchmarking Pathology Foundation Models for Breast Cancer Survival Prediction

arXiv: https://arxiv.org/abs/2604.24679 · HTML: https://mlsanity.com/paper/2604.24679/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 20 of its 46 references that are in the map.
- First posted on arXiv 27 Apr 2026.

## Builds on (most cited first, 20 of 20)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [ImageNet Large Scale Visual Recognition Challenge](https://mlsanity.com/paper/1409.0575/) (2014)
- [On the Opportunities and Risks of Foundation Models](https://mlsanity.com/paper/2108.07258/) (2021)
- [UMAP: Uniform Manifold Approximation and Projection for Dimension Reduction](https://mlsanity.com/paper/1802.03426/) (2018)
- [Multimodal Whole Slide Foundation Model for Pathology](https://mlsanity.com/paper/2411.19666/) (2024)
- [Virchow2: Scaling Self-Supervised Mixed Magnification Models in Pathology](https://mlsanity.com/paper/2408.00738/) (2024)
- [Foundational Models in Medical Imaging: A Comprehensive Survey and Future Vision](https://mlsanity.com/paper/2310.18689/) (2023)
- [Morphological Prototyping for Unsupervised Slide Representation Learning in Computational Pathology](https://mlsanity.com/paper/2405.11643/) (2024)
- [A Clinical Benchmark of Public Self-Supervised Pathology Foundation Models](https://mlsanity.com/paper/2407.06508/) (2024)
- [Benchmarking foundation models as feature extractors for weakly-supervised computational pathology](https://mlsanity.com/paper/2408.15823/) (2024)
- [Distilling foundation models for robust and efficient models in digital pathology](https://mlsanity.com/paper/2501.16239/) (2025)
- [Domain Generalization in Computational Pathology: Survey and Guidelines](https://mlsanity.com/paper/2310.19656/) (2023)
- [PathBench: A comprehensive comparison benchmark for pathology foundation models towards precision oncology](https://mlsanity.com/paper/2505.20202/) (2025)
- [Foundation Models in Computational Pathology: A Review of Challenges, Opportunities, and Impact](https://mlsanity.com/paper/2502.08333/) (2025)
- [A Survey on Computational Pathology Foundation Models: Datasets, Adaptation Strategies, and Evaluation Tasks](https://mlsanity.com/paper/2501.15724/) (2025)
- [A Comprehensive Evaluation of Histopathology Foundation Models for Ovarian Cancer Subtype Classification](https://mlsanity.com/paper/2405.09990/) (2024)
- [THUNDER: Tile-level Histopathology image UNDERstanding benchmark](https://mlsanity.com/paper/2507.07860/) (2025)
- [Scanner-Induced Domain Shifts Undermine the Robustness of Pathology Foundation Models](https://mlsanity.com/paper/2601.04163/) (2026)
- [A Comprehensive Benchmark of Histopathology Foundation Models for Kidney Digital Pathology Images](https://mlsanity.com/paper/2603.15967/) (2026)

## Built on by (most cited first, 1 of 1)

- [A Multi-Cohort Validation of Censoring-Aware Conformal Lower Predictive Bounds for Pathology Survival Models](https://mlsanity.com/paper/2608.04025/) (2026)

## Abstract (arXiv)

Pathology foundation models (PFMs) have recently emerged as powerful pretrained encoders for computational pathology, enabling transfer learning across a wide range of downstream tasks. However, systematic comparisons of these models for clinically meaningful prediction problems remain limited, especially in the context of survival prediction under external validation. In this study, we benchmark widely used and recently proposed PFMs for breast cancer survival prediction from whole-slide histopathology images. Using a standardized pipeline based on patch-level feature extraction and a unified survival modeling framework, we evaluate model representations across three independent clinical cohorts comprising more than 5,400 patients with long-term follow-up. Models are trained on one cohort and evaluated on two independent external cohorts, enabling a rigorous assessment of cross-dataset generalization. Overall, H-optimus-1 achieves the strongest survival prediction performance. More broadly, we observe consistent generational improvements across model families, with second-generation PFMs outperforming their first-generation counterparts. However, absolute performance differences between many recent PFMs remain modest, suggesting diminishing returns from further scaling of pretraining data or model size alone. Notably, the compact distilled model H0-mini slightly outperforms its larger teacher model H-optimus-0, despite using fewer than 8% of the parameters and enabling significantly faster feature extraction. Together, these results provide the first large-scale, externally validated benchmark of PFMs for breast cancer survival prediction, and offer practical guidance for efficient deployment of PFMs in clinical workflows.