# TRUST: Threshold-Recalibrated Uncertainty-Safe Training for Certified Dismissal in Breast Cancer Screening

arXiv: https://arxiv.org/abs/2609.00300 · HTML: https://mlsanity.com/paper/2609.00300/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 16 of its 40 references that are in the map.
- First posted on arXiv 31 Aug 2026.

## Builds on (most cited first, 16 of 16)

- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
- [A Gentle Introduction to Conformal Prediction and Distribution-Free Uncertainty Quantification](https://mlsanity.com/paper/2107.07511/) (2021)
- [Confounding variables can degrade generalization performance of radiological deep learning models](https://mlsanity.com/paper/1807.00431/) (2018)
- [Calibrating Deep Neural Networks using Focal Loss](https://mlsanity.com/paper/2002.09437/) (2020)
- [SelectiveNet: A Deep Neural Network with an Integrated Reject Option](https://mlsanity.com/paper/1901.09192/) (2019)
- [Conformal Risk Control](https://mlsanity.com/paper/2208.02814/) (2022)
- [Distribution-Free, Risk-Controlling Prediction Sets](https://mlsanity.com/paper/2101.02703/) (2021)
- [Deep Neural Networks Improve Radiologists' Performance in Breast Cancer Screening](https://mlsanity.com/paper/1903.08297/) (2019)
- [Mammo-CLIP: A Vision Language Foundation Model to Enhance Data Efficiency and Robustness in Mammography](https://mlsanity.com/paper/2405.12255/) (2024)
- [Conformal Risk Training: End-to-End Optimization of Conformal Risk Control](https://mlsanity.com/paper/2510.08748/) (2025)
- [Automatic segmentation with detection of local segmentation failures in cardiac MRI](https://mlsanity.com/paper/2011.07025/) (2020)
- [Domain generalization in deep learning-based mass detection in mammography: A large-scale multi-center study](https://mlsanity.com/paper/2201.11620/) (2022)
- [Understanding Calibration of Deep Neural Networks for Medical Image Classification](https://mlsanity.com/paper/2309.13132/) (2023)
- [Full Field Digital Mammography Dataset from a Population Screening Program](https://mlsanity.com/paper/2411.02710/) (2024)
- [Dataset-Origin Signatures and Shortcut Learning in Screening Mammography AI: A Cross-Dataset Case Study](https://mlsanity.com/paper/2607.15416/) (2026)

## Abstract (arXiv)

Reducing the review of clearly cancer-negative screening mammograms could lower radiologist workload without compromising cancer detection. We propose a closed-loop threshold-aware training strategy in which the dismissal threshold is recalculated during training and used to penalize cancer-positive images that approach the dismissal region. We evaluated the method on NLBS and RSNA using five controlled training configurations, with case-level assessment based on a one-sided 99% Clopper--Pearson upper bound for cancer prevalence among dismissed cases. The proposed model achieved the highest case-level dismissal rates at both 98% and 95% recall targets. On NLBS, dismissal reached 19.74% and 21.70%, while the cross-entropy baseline did not meet either recall target. On RSNA, dismissal improved from 7.04% to 14.31% and from 13.49% to 19.69%. In external RSNA→NLBS evaluation, the proposed model achieved dismissal rates of 12.95% and 19.87% at the 98% and 95% recall targets, respectively. These results support closed-loop threshold-aware training for high-recall selective dismissal.