Article

Breast Cancer Detection and Prevention Using Machine Learning

Arslan Khalid 1, Arif Mehmood 1, Amerah Alabrah 2,*, Bader Fahad Alkhamees 2 and Farhan Amin 3,*,
Hussain AlSalman 4 and Gyu Sang Choi 3

1 Faculty of Computing, Islamia University of Bahawalpur, Bahawalpur 63100, Punjab, Pakistan;

[email protected] (A.K.); [email protected] (A.M.)
2 Department of Information Systems, College of Computer and Information Science, King Saud University,

Riyadh 11543, Saudi Arabia; [email protected]

3 Department of Information and Communication Engineering, Yeungnam University,

Gyeongsan 38541, Republic of Korea; [email protected]

4 Department of Computer Science, College of Computer and Information Sciences, King Saud University,

Riyadh 11543, Saudi Arabia; [email protected]

* Correspondence: [email protected] (A.A.); [email protected] (F.A.)

Abstract: Breast cancer is a common cause of female mortality in developing countries. Early detec-
tion and treatment are crucial for successful outcomes. Breast cancer develops from breast cells and
is considered a leading cause of death in women. This disease is classified into two subtypes: inva-
sive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). The advancements in artificial
intelligence (AI) and machine learning (ML) techniques have made it possible to develop more ac-
curate and reliable models for diagnosing and treating this disease. From the literature, it is evident
that the incorporation of MRI and convolutional neural networks (CNNs) is helpful in breast cancer
detection and prevention. In addition, the detection strategies have shown promise in identifying
cancerous cells. The CNN Improvements for Breast Cancer Classification (CNNI-BCC) model helps
doctors spot breast cancer using a trained deep learning neural network system to categorize breast
cancer subtypes. However, they require significant computing power for imaging methods and pre-
processing. Therefore, in this research, we proposed an efficient deep learning model that is capable
of recognizing breast cancer in computerized mammograms of varying densities. Our research re-
lied on three distinct modules for feature selection: the removal of low-variance features, univariate
feature selection, and recursive feature elimination. The craniocaudally and medial-lateral views of
Citation: Khalid, A.; Mehmood, A.; mammograms are incorporated. We tested it with a large dataset of 3002 merged pictures gathered
Alabrah, A.; Alkhamees, B.F.; Amin, from 1501 individuals who had digital mammography performed between February 2007 and May
F.; AlSalman, H.; Choi, G.S. Breast
2015. In this paper, we applied six different categorization models for the diagnosis of breast cancer,
Cancer Detection and Prevention
including the random forest (RF), decision tree (DT), k-nearest neighbors (KNN), logistic regression
Using Machine Learning. Diagnostics
(LR), support vector classifier (SVC), and linear support vector classifier (linear SVC). The simula-
2023, 13, 3113. https://doi.org/
tion results prove that our proposed model is highly efficient, as it requires less computational
10.3390/diagnostics13193113
power and is highly accurate.
Academic Editor: Jae-Ho Han

Received: 4 September 2023 Keywords: breast cancer; healthcare; machine learning

Revised: 25 September 2023
Accepted: 28 September 2023
Published: 2 October 2023
1. Introduction
Cancer is a worldwide epidemic that affects individuals of all ages and backgrounds.
Copyright: © 2023 by the authors. Li- There are many types of cancer, however, breast cancer is one of the most common cancers
censee MDPI, Basel, Switzerland. in women. Due to this challenge, researchers should pay special attention to cancer detec-
This article is an open access article tion and prognosis. Predicting and diagnosing cancer at an early stage is an area where
distributed under the terms and con- machine-learning approaches may have a significant impact. Breast cancer develops from
ditions of the Creative Commons At-
breast cells and is a frequent malignancy in females worldwide. Breast cancer is second
tribution (CC BY) license (https://cre-
only to lung cancer as a leading cause of death in women [1]. The risk of breast cancer can
ativecommons.org/licenses/by/4.0/).
be due to the following causes: age is a major factor in the development of breast cancer.

Diagnostics 2023, 13, 3113. https://doi.org/10.3390/diagnostics13193113 www.mdpi.com/journal/diagnostics

Diagnostics 2023, 13, 3113 2 of 21

Breast cancer is more prevalent in females, but males are not immune to the disease. Hav-
ing a mother, sister, or daughter who has been diagnosed with breast cancer increases an
individualʹs risk. Breast cancer risk increases with the presence of certain gene mutations,
such as those in the BRCA1 and BRCA2 genes. The use of HRT (hormone replacement
therapy) for an extended period may raise the risk. Premature menstruation, delayed
menopause, and a lack of children or delayed puberty are all factors that might affect a
woman’s risk. The symptoms of breast cancer are the following: isolated swelling of the
breast or armpit; alterations in breast size, form, or appearance; breast or nipple discom-
fort which cannot be explained medically; nipple discharge other than breast milk; and
discoloration or dimples in the breast skin. The microscopic appearance of breast cancer
cells is used to classify the disease into several subtypes. Ductal Carcinoma In Situ (DCIS)
is a non-invasive or pre-invasive breast cancer that originates in milk ducts and does not
invade nearby tissues. It can sometimes progress to invasive breast cancer if left untreated.
Invasive ductal carcinoma (IDC) is the most common type, accounting for 80% of cases,
and invades nearby breast tissues. IDC can be classified based on hormone receptor status
and HER2 status. Invasive lobular carcinoma (ILC) originates in the milk-producing
glands and accounts for 10–15% of breast cancer cases. It is less common than IDC and is
more difficult to detect with mammography. Triple-negative breast cancer (TNBC) is a
subtype of breast cancer that lacks hormone receptors and the HER2 protein. It is more
aggressive and less responsive to hormonal and HER2-targeted therapies. TNBC is often
treated with chemotherapy. HER2-positive breast cancer is a rare and aggressive form of
breast cancer caused by overexpression of the human epidermal growth factor receptor 2
(HER2) protein. It can be invasive or non-invasive, and it can be treated with targeted
therapies such as Herceptin. Inflammatory breast cancer (IBC) is a rare and aggressive
form characterized by redness, warmth, and swelling of the breast. It requires immediate
and aggressive treatment. Paget ’s disease of the Nipple is a rare and aggressive form that
starts in the milk ducts and spreads to the skin of the nipple and areola. Metastatic breast
cancer, also known as stage IV, is a non-curable disease that can be any subtype of breast
cancer (IDC, ILC, or HER2-positive) and is generally not curable. Treatments aim to con-
trol and manage the disease. Invasive ductal carcinoma (IDC) and ductal carcinoma in
situ (DCIS) are the two most common forms of breast cancer, with DCIS developing more
slowly and usually without affecting patients’ everyday lives. DCIS accounts for a very
modest number of breast cancer instances (20–53%), while IDC is far more hazardous
since it spreads across the breast. About 80% of people diagnosed with breast cancer fall
into this group [2]. The majority of breast cancers are invasive, indicating that the illness
has spread to other organs or tissues beyond the breast. The two most common types of
invasive breast cancer are invasive ductal carcinoma (IDC) and invasive lobular carcinoma
(ILC). Invasive ductal carcinoma is a kind of breast cancer that develops in the milk ducts
and then metastasizes to other parts of the breast. Invasive lymphoma is more difficult to
detect using standard screening procedures. Initially developing in the lobules that secrete
milk, inflamed lobular carcinoma (ILC) may spread to other parts of the breast [3]. Only
1–4% of women with a breast cancer diagnosis will go on to develop invasive ductal car-
cinoma in situ, a type of breast Paget disease. It is an uncommon tumor that develops in
the skin surrounding the breasts and produces Paget cells. Due to its rapid growth rate,
breast angiosarcoma is often diagnosed after it has already spread to other parts of the
body. The phyllodes seldom become malignant growths, and when they do, they mostly
affect middle-aged women. The other types of invasive breast cancer include adenocarci-
noma, adenosquamous carcinoma, medullary carcinoma, mucinous carcinoma, papillary
carcinoma, and tubular carcinoma, each of which is very uncommon [4]. Cancer cells in a
noninvasive breast tumor stay localized inside the affected breast region rather than
spreading to nearby lobules or ducts. In the case of breast cancer, the disease has not
spread beyond the affected area. There are two types of in situ cancer: ductal carcinoma
in situ (DCIS) and lobular carcinoma in situ (LCIS) [5]. Cancer of the milk duct, or ductal
Diagnostics 2023, 13, 3113 3 of 21

carcinoma in situ (DCIS), occurs when a mass forms within the duct that carries milk from
the lobules or glands to the nipple.
Recent advances in diagnostic and treatment methods have led to a positive progno-
sis for those who have been treated for DCIS, even if there is no proof that cancer has
spread to other organs [6]. However, LCIS may promote the growth of cells that resemble
cancerous ones, so it is important to treat it as if it were. Most cases of LCIS remain local-
ized; however, because of the increased risk of invasive breast cancer, doctors may opt to
monitor their patients anyway. Early detection of cancer is key to the successful treatment
of breast cancer. Therefore, the availability of appropriate screening technologies is crucial
for spotting the first signs of breast cancer. Screening for this condition may be performed
using a variety of imaging modalities, the most common of which are mammography,
ultrasonography, and thermography. Mammography is an important tool for detecting
breast cancer in its earliest stages. Since mammography is ineffective for women with
dense breast tissue, diagnostic ultrasound is often used instead. Radiation from radiog-
raphy and thermography may be more accurate than ultrasonography for detecting tiny
malignant tumors due to these factors. Mammography is a crucial tool in the fight against
breast cancer, and thanks to advancements in artificial intelligence, it can now automati-
cally identify illnesses in medical photos. Early-stage breast cancer detection faces several
limitations and challenges. Breast cancer screening methods, such as mammography, face
several challenges, including sensitivity, specificity, breast density, overdiagnosis, over-
treatment, screening age and frequency, access and equity, patient compliance, cost, and
resource constraints, a false sense of security, risk prediction, genetic and molecular fac-
tors, variability in screening interpretation, and invasive follow-up tests. Mammography
may miss early-stage tumors, particularly in women with dense breast tissue, resulting in
false negatives and unnecessary follow-up tests. Dense breast tissue can obscure small
tumors on mammograms, reducing sensitivity and requiring additional imaging tests.
Overdiagnosis and overtreatment can occur when early-stage breast cancers are slow-
growing and non-aggressive. Screening age and frequency may vary by country and or-
ganization, leading to confusion among patients and healthcare providers. Access to
breast cancer screening can be limited by socioeconomic factors, geographic location, and
healthcare disparities, resulting in missed opportunities for early detection. Patient com-
pliance, cost and resource constraints, and genetic and molecular factors also contribute
to the challenges faced in breast cancer screening. Patients anxiously anticipating biopsy
findings indicating benignity may be subjected to unnecessary follow-up workups and
biopsies if the diagnostic yield is only moderately specific. Over the last several decades,
methods have been included in the normal clinical evaluation of breast MRI tests that ex-
amine various MRI [7] sequences alongside DCE-MRI pictures to overcome this constraint
and analyze more functional data. T2-weighted (T2w) MRI is an often-used supplemen-
tary sequence in this method, which is known as multi-parametric magnetic resonance
imaging (mpMRI). Differentiating benign from malignant lesions may be aided by includ-
ing T2W sequence interpretation, according to studies. As an example, fibroadenomas, a
benign lesion that may demonstrate comparable contrast agent enhancement to that of
malignant lesions on T1-weighted DCE-MRI, often have higher signal intensity on T2w
images compared with malignant lesions [8]. Instruments have been produced to make
and enhance image processing because of the inherent challenges connected with a pic-
ture, such as low contrast, noise, and underappreciation by the human eye. Convolutional
neural networks (CNNs) [9], a subfield of machine learning, and artificial intelligence (AI)
are some of the healthcare industry’s hottest new trends. Artificial intelligence (AI) [10]
and machine learning (ML) may be found in the field of study that focuses on developing
better technological systems to handle complicated tasks with less reliance on human in-
tellect [11].
The purpose of this research is to create an efficient deep learning-based model. The
proposed model is capable of recognizing breast cancer in computerized mammograms
of varying densities and then comparing the achieved results using state-of-the-art models.
Diagnostics 2023, 13, 3113 4 of 21

We proposed an efficient deep learning model that is capable of recognizing breast cancer
in computerized mammograms of varying densities. Our research relied on three distinct
modules for feature selection: the removal of low-variance features, univariate feature se-
lection, and recursive feature elimination. The craniocaudally and medial-lateral views of
mammograms are incorporated. We suggested craniocaudally and medial-lateral views
of mammograms in our proposed model. This resulted in a total of 3002 merged pictures
from 1501 individuals who had digital mammography performed between February 2007
and May 2015. It has been observed that breast MRI is a very sensitive imaging technique
for detecting and characterizing breast cancer. We obtained excellent sensitivity and var-
ied specificity for breast cancer. The diagnosis was obtained using dynamic contrast-en-
hanced (DCE) MRI. This provides morphological and functional lesion information.
The Table 1 gives a concise overview of different diagnostic techniques along with
both benefits and drawbacks. This serves as a fast reference for readers to comprehend the
state of breast cancer diagnosis today and the need for an enhanced diagnostic strategy.

Table 1. Existing diagnostic method, advantages, and limitations.

Existing Diagnostic
Advantages Limitations
Method
Limited sensitivity in dense breast tis-
Well-established
sue
Mammography
Widely accessible False positives/negatives
Detects structural changes and calcifications False positives/negatives
No radiation Limited specificity
Ultrasound Useful for dense breasts Operator-dependent
Differentiates cysts from solid masses Limited detection in deep tissues
High sensitivity High cost
MRI (Magnetic ResonanceNo radiation Longer exam duration
Imaging) Requires specialized expertise to detect
Detailed soft tissue visualization
benign lesions
Provides tissue samples for definitive diagnosis Invasive and uncomfortable
Biopsy (Fine Needle Aspi-
Small risk of complications
ration or Core Needle Bi-
High diagnostic accuracy Requires skilled medical staff
opsy)
Sample may not be representative
No radiation Limited sensitivity
Clinical Breast Examina-
Low cost Dependent on examiner’s expertise
tion (CBE)
Can detect palpable masses May miss non-palpable masses
Applicable to specific subsets of pa-
Identifies genetic mutations linked to increased risk
Genetic Testing tients
(BRCA1/BRCA2 Testing) Enables targeted prevention and treatment strate-Limited to hereditary breast cancer
gies cases

1.1. Motivation
Breast cancer diagnosis by machine learning has been motivated by the hope that it
will lead to better patient outcomes, lessen the disease’s worldwide effect, and aid in the
development of cutting-edge healthcare technology and research.
Diagnostics 2023, 13, 3113 5 of 21

1.2. Benefits of This Research

The benefits of this research are as follows; it helps in improvement in early diagnosis
and individualized therapy. In addition, it has the potential to revolutionize breast cancer
management and save lives by influencing areas such as research, cost-effectiveness, and
worldwide accessibility to healthcare services. It helps in reducing healthcare costs, and a
more beneficial influence on worldwide breast cancer management is all possible because
of the abilities of machine learning in breast cancer diagnosis.
The rest of the paper is organized as follows. In Section 2 we discuss the previous
research in the related work section. In Section 3 we presented our proposed methodology.
In Section 4 we discuss the achieved experimental results. Section 5 concludes the conclu-
sion of this study.

2. Literature Review
In recent years, several studies have used ML (machine learning) techniques in
healthcare domains to detect BC. Since the algorithms provide satisfactory results, other
scientists have used them to address challenging issues [12]. A CNN algorithm was em-
ployed to predict and diagnose invasive ductal carcinoma in breast cancer images, and it
achieved an accuracy of about 88% [13,14]. In addition, it is often used in the medical field
for forecasting and diagnosing anomalous occurrences to obtain a deeper understanding
of incurable disorders such as cancer [15]. Numerous studies have focused on breast can-
cer detection strategies that use imaging and genetics. Furthermore, to our knowledge, no
studies have been conducted that use both of these approaches together. In [16], the au-
thors summarized the several techniques used for histological image analysis (HIA) in
breast cancer diagnosis. Different types of convolutional neural networks (CNN) serve as
the foundation for these techniques [17]. Based on the kind of dataset they used, the writ-
ers classified their work accordingly. They organized everything in reverse chronological
order, with the most recent occurrence at the beginning. This study’s results suggest that
ANNs were first put to use in the area of HIA sometime in the middle of 2012. The most
common types of algorithms used were ANNs and PNNs [18].
However, morphological and textural characteristics were heavily used in feature ex-
traction. It is clear that using deep convolutional neural networks to detect and diagnose
breast cancer at an early stage improves outcomes for patients undergoing treatment. The
process of creating NCD predictions included the use of several different algorithms. In
[19], the authors investigated and evaluated several categorization strategies for their ef-
fectiveness. The classification algorithms were tested on eight separate NCD datasets us-
ing a 10-fold cross-validation strategy. The area under the curve is used to analyze these
results for precision. The authors state that the NCD datasets have irrelevant features and
noisy data. The resiliency of KNN, SVM, and NN in the face of this noise is impressive.
They also suggested various preprocessing processes that would raise the rate of accuracy
and remove the problem of irrelevant attributes. Several human health disorders have
been presented as candidates for which natural inspiration computing (NIC) approaches
might be useful in the diagnostic process. The authors of [20] proposed five NIC diagnos-
tic algorithms based on insects and addressed their potential use in diagnosing diabetes
and cancer. Breast, lung, prostate, and ovarian tumors were all successfully recognized,
as claimed by the authors. A breast cancer diagnosis is improved by integrating directed
ABC with neural networks. The authors also developed a very effective technique for
identifying diabetes and leukemia. Incorporating NICs with conventional classification
techniques, they reasoned, yields more reliable and encouraging results. They stressed the
need for further research into diabetes and illness detection at different stages. In [21], the
authors reported data suggesting NNs may be used to classify cancer diagnoses, espe-
cially in the early stages of the illness. Their findings show that a variety of NNs have
Diagnostics 2023, 13, 3113 6 of 21

shown promise in identifying cancerous cells. However, a significant amount of compu-

ting power is required for the imaging method’s preprocessing of the pictures. In the fol-
lowing, we explore how CNNs and AI can minimize challenges.
CNNs and AI can improve medical image quality by enhancing low-contrast features,
reducing noise, removing artifacts, and optimizing image registration. They can also assist
in image, segmentation, and ROI detection, enabling precise analysis and diagnosis of an-
atomical structures or lesions. AI algorithms can adjust image contrast, brightness, and
intensity levels and apply contrast-limited adaptive histogram equalization (CLAHE)
techniques to improve image quality. Additionally, CNNs can recognize and remove com-
mon imaging artifacts, ensuring accurate interpretation. AI algorithms optimize image
alignment, while segmentation and ROI detection enable precise analysis and diagnosis
of specific areas. Finally, CNNs can be used for super-resolution imaging, enhancing im-
age resolution and quality beyond the original acquisition. AI-driven super-resolution
techniques use deep learning models to generate high-resolution images from low-reso-
lution inputs, providing enhanced detail and diagnostic information.
Practical techniques in the field of smart health include computational intelligence
methods such as fuzzy systems, artificial neural networks, and swarm intelligence, or evo-
lutionary computing methods including genetic algorithms, classifiers, and support vec-
tor machines (Al-Antari, Al-Masni et al. 2018) [22]. The suggested CNN Improvements for
Breast Cancer Classification (CNNI-BCC) model helps doctors spot breast cancer, as
shown in research in Khan, Khan et al. 2020) [21]. The suggested method uses a trained
deep learning neural network system to categorize breast cancer subtypes. According to
data from 221 actual patients, the findings have an accuracy of 90.50 percent. Without
needing any human intervention, this model can classify and identify breast cancer lesions.
Evaluating this model shows that it can examine the situation of impacted patients
throughout the detection phase, showing that it is an improvement over earlier techniques
(Tanabe, Ikeda et al. 2020) [23].
Sivapriya, Kumar, et al. 2019 [24], compared SVM, logistic regression, naive Bayes,
and random forest to determine their parallels and distinctions. Wisconsin’s breast cancer
dataset is used for comparative purposes (Abunasser, AL-Hiealy et al., 2022) [25]. The re-
sults of the evaluations showed that the random forest algorithm achieved the highest
level of accuracy (99.76%) with the least amount of error. The Anaconda Data Science Plat-
forms were used to run all the experiments in a reproducible environment [26]. The au-
thors (Allugunti 2022) proposed an approach for breast cancer that classifies the disease
into its various subgroups. Features are chosen using data from the Wisconsin Diagnosis
and Analysis and Prognostic Breast Cancer databases (Gonzalez-Angulo, Morales-
Vasquez et al. 2007) [27]. The different types of breast cancer are then categorized using a
neural network technique, with special emphasis on the multilayer perceptron (MLP) and
the back-propagation neural RBF. The nine characteristics in this dataset stand for the
neural network’s input layer. The neural network will classify the input information into
two types of cancer (benign and malignant). Using the RBF neural network, the method
developed and evaluated on the database achieved a 97% repeatability of classification.
Two different Bayesian classifiers, tree-augmented naive Bayes and Markov blanket esti-
mating networks, were evaluated and compared by the authors (Elsayad 2010) [28] to
build an ensemble model for the prediction of the severity of breast masses.
The proposed methodology is developed to help doctors decide whether or not to
conduct a breast biopsy on a suspicious lesion after reviewing the findings of a mammo-
gram. Based on Bayesian classifiers, they have been shown by the authors to be a compet-
itive alternative to other approaches with medical applications. In the realm of emergency
medicine, where BN is a beneficial approach because of its potent symbol and manage-
ment of ambiguity, and where several alternatives are feasible depending on the data that
has been provided, the authors (Krizmaric and Mertik 2008) [29] have decided to adopt
Bayesian networks (BN). The symbolic representation inside Bayesian networks is what
makes them such a powerful approach. The random forest (RF) classifier is an ensemble
Diagnostics 2023, 13, 3113 7 of 21

method that employs many different classification techniques. Every one of them may be
put into action using a decision tree. Improved classification accuracy is achieved via the
use of numerous decision trees (Dai, Chen, et al. 2018) [22]. In simple terms, the RF is an
ensemble classifier made up of many decision trees that work together to improve effi-
ciency and prediction accuracy. In Nguyen, Wang, et al. (2013) [30], researchers created an
RF-based classifier. The algorithm they used has been trained on two datasets, and the
findings are encouraging: it achieved high accuracy and good performance. Three classi-
fiers—nearest neighbor (NB), radial basis function (RF), and k-nearest neighbors (KNN)—
have been compared using the WDBC. The accuracy of these classifiers in predicting
breast cancer tumors is evaluated by training and testing on the aforementioned dataset.
The authors of this study found that although all of the classifiers they tested achieved
detection accuracy rates of over 94%, KNN fared the best. Its accuracy is better than that
of both the NB and RF classifiers. In addition to its superior accuracy, the KNN classifier
also has a higher precision and F1-score (Sharma, Aggarwal, et al. 2018) [31]. According
to Price and Lindquist, the ANN classifier outperforms the SVM, NB, or decision tree clas-
sifiers when using feature selection techniques. Its efficiency saw a 51 percent boost as a
result of these changes (Kabiraj, Raihan et al. 2020) [32]. In Al-Azzam and Shatnawi (2021)
[33], the authors evaluate two machine learning classifier models, extreme gradient boost
(XGBoost) and RF, using a small dataset consisting of 275 examples. Using a limited da-
taset may reflect incorrect results; hence, the authors argue that a large dataset is necessary
to validate their conclusions, even if their results suggest that RF has outperformed
XGBoost when it comes to accuracy in detecting breast cancer. LR, Gaussian naive Bayes,
RBF SVM, linear SVM, DT, RF, XGBoost, KNN, and gradient boosting are only some of
the nine classification models that were examined in recent research. The Wisconsin Di-
agnosis Cancer Dataset is used for both training and testing the models. Based on the data,
we can conclude that KNN is the most effective method for supervised learning, while LR
is the most effective method for semi-supervised learning (Wang, Wang et al. 2020) [34].
One of the most incomplete methods to provide a trade-off between variance and bias is
the ensemble learning technique. Classification performance may be improved by merg-
ing individual classifiers to construct an aggregated classification model, as has been
shown in several studies. Stacking, boosting, and bagging are the three foundational
methods of ensemble classification. The stacking method involves combining the results
of several categorization models into a single one (Tang, Cai, et al., 2021) [35].

3. Proposed Methodology
In this paper, we applied six different categorization models for the diagnosis of
breast cancer, including the random forest (RF), decision tree (DT), k-nearest neighbors
(KNN), logistic regression (LR), support vector classifier (SVC), and linear support vector
classifier (linear SVC). It is important to remember that the chosen dataset and objectives
may dictate different hyperparameter values and other implementation-specific choices.
Mammography, computed tomography, magnetic resonance imaging, positron emission
tomography, blood testing, and genetic analysis all have their limitations when it comes
to early diagnosis and prognosis. State-of-the-art techniques may require invasive treat-
ments, incorrect diagnoses, and specialist knowledge. Early diagnosis, improved accuracy,
personalized therapy, risk assessment, data integration, predictive prognosis, and drug
development are just some of the ways machine learning technologies might boost cancer
detection and prognosis. The existing process for identifying possible chemicals and treat-
ments for cancer therapy is time-consuming and prone to mistakes; these strategies assist
in speeding up the process.
Mammography is an X-ray imaging technique designed for breast tissue using dif-
ferential X-ray absorption. It is primarily used for breast cancer screening, early detection,
and diagnosis, detecting small abnormalities, e.g., tumors and microcalcifications. Ultra-
sound, on the other hand, uses high-frequency sound waves to create images of breast
tissue. It is often used to complement mammography, distinguishing between solid
Diagnostics 2023, 13, 3113 8 of 21

masses and fluid-filled cysts and providing additional information about a breast abnor-
mality’s characteristics. Ultrasound is also used to guide breast biopsies.
Thermography, also known as thermal imaging, captures heat patterns emitted by
the body’s surface. It uses a specialized camera to measure the temperature of the skin’s
surface, revealing temperature variations in areas with increased blood flow, such as
around tumors. Thermography has been explored as a non-invasive tool for breast cancer
screening but is not widely used as a standalone method due to concerns about accuracy
and variability in interpreting results. It may be used as an adjunctive tool in certain cases
or for breast health monitoring.
Mammography is the gold standard for breast cancer screening and is widely recom-
mended in many countries. Ultrasound is often used as a complementary tool, particu-
larly for dense breast tissue. Thermography is not recommended as a primary screening
tool due to concerns about sensitivity and specificity. The choice of screening modality
depends on a patient’s age, risk factors, breast density, and clinical circumstances and is
determined by healthcare providers in consultation with patients.
Different ensemble approaches are used by the RF classifier and the KNN classifier,
both of which are ensemble classifiers. The bagging method is crucial to RF. Tree-based
classifiers make up this set. The stack classifier is a stacking-based classifier that uses the
results of other classification models as inputs. By switching between classifiers that are
predicated on various methods and use cases, we hope to improve the reliability of our
findings.
Figure 1 shows our proposed methodology. In this figure, the data is taken from the
dataset. Prepare the data to use the breast cancer dataset by loading it. Separate the infor-
mation into features (X) and labels (y). For quantitative analysis of features, ensure each
feature has the same effect on the algorithms by normalizing or standardizing them. Sep-
arate the data into a training set and a test set. Seventy percent for instruction and thirty
percent for testing is an example of a frequent breakdown. For the evaluation and training
of models, random forest (RF), decision tree (DT), k-nearest neighbors (KNN), logistic re-
gression (LR) and linear support vector classifier (linear SVC) are used and the effective-
ness of each algorithm is evaluated using the criteria provided. Select the most effective
algorithm for spotting breast cancer. To determine which attributes are most important
for algorithms such as RF and DT, perform a feature importance analysis. To better un-
derstand the algorithm’s decision-making process, decision trees may be represented
graphically.
The objective of preprocessing is to replace duplication values in data. The data bal-
ancing is performed by using a data balancer. Then we performed feature extraction on it.
The achieved data has been sent to the data splitting. Here, a specific algorithm is applied
and hence the data is divided into two sets. One is training and the other is testing data.
Our data were split into 70% training data and 30% testing data, and different ML classi-
fiers were applied, such as DT, RF, LR, SVC, and KNN to find their individual detection
and prevention accuracy levels for breast cancer. The raw breast cancer data is processed
to resize the features with the Standard Scaler module as part of this research. Many esti-
mators in the field of machine learning need the standardization of datasets. Typically,
feature selection is used before any real learning is performed as a kind of preprocessing.
However, without informative and discriminative characteristics, no algorithm can pro-
duce accurate predictions; hence, it is important to retain the most important features
while decreasing the dataset size. We have used Python’s sci-kit-learn package to con-
struct the feature-selection module. In addition, we have used too many criteria used by
all selection procedures, making it impossible to prioritize the most important ones.
Diagnostics 2023, 13, 3113 9 of 21

Figure 1. Proposed methodology.

Implementations of the IMPEL algorithm are used for picture categorization. Collect
a series of photos that will be used in the categorization process. Each picture in this col-
lection should have a label indicating which category it belongs to. Creating variants of
the photos by rotation, flipping, or adjusting brightness and contrast are all examples of
preprocessing that may be used to prepare the images for analysis. It may be necessary to
extract characteristics from photos to use them with common machine-learning tech-
niques. Histogram of Oriented Gradients (HOG), Scale-Invariant Feature Transform
(SIFT), and deep feature extraction using pre-trained convolutional neural networks
(CNNs) such as VGG, ResNet, and Inception are used. For picture categorization, choose
a machine-learning model that works well. Common alternatives are deep learning archi-
tectures: CNNs automatically learn useful characteristics from the input, making them
very effective for image applications. If feature extraction is achieved, models such as sup-
port vector machines (SVMs), random forests, k-nearest neighbors (KNN), or logistic re-
gression are used. For model instruction: evaluate the chosen model using the training
data. Feed the photos into the CNN and tweak the model’s weights until the classification
error is as small as possible. Use the validation dataset to fine-tune the model’s hyperpa-
rameters (such as the learning rate, batch size, and number of layers) for optimal perfor-
mance.
Our study relied on three distinct modules for feature selection: the removal of low-
variance features, univariate feature selection, and recursive feature elimination. Com-
pared to using only one model, the prediction performance of ensembles of machine learn-
ing algorithms is often superior, as was proven by a breast cancer diagnostic model that
won a machine learning competition. The information that is given here is classified using
the following multimodal sets of machine learning algorithms: linear SVC, SVC, KNN,
DT, RF, LR, DT, and logistic regression. There are now training, validating, and testing
datasets available from the original dataset. The distribution is divided as follows: 30% to
70%. (1) Accuracy (2), precision (3), recall (4), and F1-score; all standard metrics have been
used to evaluate the proposed model’s efficacy.
Diagnostics 2023, 13, 3113 10 of 21

Testing the suggested model(s) created is part of evaluating an ML algorithm’s per-

formance. In this study, the assessment is carried out by contrasting model findings with
actual data values. In this step, known as the prediction phase, the performance of the
models in identifying benign and malignant tumors is evaluated using the test dataset.
Malignant tumor classification is a major hurdle in the way of its discovery. They
suggest machine learning (with SVMs) to categorize these tumors, using the Breast Cancer
Wisconsin (diagnostic) dataset. The objective of this dataset is as follows:
• Learn the dataset and clean it up (if necessary).
• Create models for classifying cancers as either malignant or benign.
• Adjust the hyperparameters and evaluate the metrics of different classifiers.
A form of evolutionary algorithm (EA) known as genetic programming (GP) gener-
alizes the genetic algorithm. GP is a model for testing and choosing the best option from
a group of outcomes. GP creates a solution based on biological evolution and its basic
process (mutation, crossover, and selection).
The usage of GP accounts for its adaptability; it can model systems even when the
required models’ structure and salient characteristics are unknown. For the classification
challenge in this study, GP enabled the system to search for models from a variety of po-
tential model architectures while optimizing the pipelines shown as tree topologies. Based
on the aforementioned primitives, such as the features selection decomposition, GP first
constructs a certain number of pipelines. In other words, the order of operators changes
as machine learning pipelines are reviewed to generate the highest possible categorization
accuracy. A new generation is developed using the best prior pipelines after evaluating
the present machine learning pipelines. Every pipeline is regarded as a unique member
of GP. The three main operators make up the GP:
• Altering hyperparameters or adding or deleting a simple preprocessing step, such as
Standard Scaler or the number of trees in a random forest, are examples of mutation
operators.
• Crossover operator: using a 1-point crossover chosen at random, the crossover oper-
ator estimates that 5% of people will cross paths with one another.
• The major objective of the selection operator is to choose the top 20 people and create
clones of them. The crossover or mutation operator may be used to communicate
information between population members.
Table 2 presents the metrics description of the confusion matrix. In this table, we com-
pare the anticipated outcomes with the actual numbers. The performance of the classifier
is calculated using the matrix. Several performance metrics, including accuracy, an area
under the precision, recall, sensitivity, and f1-score, may be used to assess the effective-
ness of the ML model.

Table 2. Description of metrics.

Metrics Description
Positive Negative
Positive True Positive (TP) False Positive (FP)
Confusion Metrics
Negative False Negative (TP) True Negative (TN)
Precision =

4. Results and Discussion

In this research, we have provided a standardized method for comparing the state-
of-the-art using the assessment measures EDA dataset. At first, we collected the source
from kaggle.com (accessed on 15April 2023). We have used Python Jupiter Notebook
6.4.12 for the simulation. Table 3 presents the first result of explanatory data analyses us-
ing different models. EDA resources include Python extensions such as Pandas, Seaborn,
Diagnostics 2023, 13, 3113 11 of 21

Plotly, and Bokeh. Pandas is a robust library for data analysis, offering DataFrames and
Series. Seaborn is a high-level interface for creating statistical visualizations, while Plotly
is a flexible framework for creating interactive visualizations such as dashboards and 3D
plots. Bokeh is a library for creating interactive dashboards for online use. In this graph,
the predictions are used with the subsets of the dataset. Each set consists of 70% of the
training data and 30% of the test data. The table summarized and compared with id, ra-
dius_mean and other measures.
Keep in mind that the variety of the individual models and their capacity to capture
various features of the data are essential to the success of an ensemble model. Throughout
the process, careful model selection, training, and assessment are crucial. The ensemble
model must be monitored and maintained when new data becomes available or the clini-
cal setting changes.

Table 3. Exploratory data analysis.

(a)
Tex- Perime- Smooth- Compact- Concav- Concave Ra-
id Diagnosis Radius_Mean Area_Mean
ture_Mean ter_Mean ness_Mean ness_Mean ity_Mean Points_Mean dius_Worst
0 842302 M 17.99 10.38 122.80 1001.0 0.11840 0.27760 0.3001 0.14710 25.38
1 842517 M 20.57 17.77 132.90 1326.0 0.08474 0.07864 0.0869 0.07017 24.99
2 84300903 M 19.69 21.25 130.00 1203.0 0.10960 0.15990 0.1974 0.12790 23.57
3 84348301 M 11.42 20.38 77.58 386.1 0.14250 0.28390 0.2414 0.10520 14.91
4 84358402 M 20.29 14.34 135.10 1297.0 0.10030 0.13280 0.1980 0.10430 22.54
(b)
Tex- Perime- Smooth- Compact- Concav- Concave Sym- Fractal_Dimen-
Area_Worst Unnamed: 32
ture_Worst ter_Worst ness_Worst ness_Worst ity_Worst points_Worst metry_Worst sion_Worst
17.33 184.60 2019.0 0.1622 0.6656 0.7119 0.2654 0.4601 0.11890 NaN
23.41 158.80 1956.0 0.1238 0.1866 0.2416 0.1860 0.2750 0.08902 NaN
25.53 152.50 1709.0 0.1444 0.4245 0.4504 0.2430 0.3613 0.08758 NaN
26.50 98.87 567.7 0.2098 0.8663 0.6869 0.2575 0.6638 0.17300 NaN
16.67 152.20 1575.0 0.1374 0.2050 0.4000 0.1625 0.2364 0.07678 NaN

The above data analysis method would be incomplete without the exploratory data
analysis (EDA) phase. Analyzing data entails visualizing it to draw conclusions, recognize
trends, spot outliers, and make hypotheses. EDA is useful for gaining a grasp of the da-
taset’s structure and properties before moving on to more complex statistical and machine
learning methods. Understanding the features of the dataset, spotting data quality con-
cerns, and identifying early patterns that might drive further analysis and modeling
choices are all accomplished using EDA, making it a crucial phase in the data analysis
process. It is also vital to the trustworthiness of the results obtained from the data.
Figure 2 presents the boxplots of the breast cancer dataset. In this figure, these box-
plots present the distribution of breast cancer detection scores. There is an anomaly in all
the graphs we acquired. If we remove them, the data’s median will go down, and that
might provide a challenge in accurately identifying cancers, particularly if a malignant
tumor is misidentified as benign. We will only remove anomalies in benign tumors, how-
ever, so as not to interfere with the detection of dangerous cancers. After processing, the
maximum value of the area ‘worst’ is 932.7, down from 1210.0 before processing. The
maximum area of mean value has similarly decreased, from 992.1 before processing to
788.5. This might lead to false positives, in which benign tumors are mistakenly labeled
as cancerous. On the other hand, this strategy is preferable to the alternative. This diagno-
sis has the potential to save lives by detecting cancers at an early stage when treatment is
most effective.
Diagnostics 2023, 13, 3113 12 of 21

Figure 2. Boxplots of breast cancer dataset.

Breast cancer screening involves mammography to detect the early stages of the dis-
ease, identifying abnormalities such as tumors or microcalcifications. The procedure in-
volves gently compressing the breast between two plates, resulting in two X-ray images.
Radiologists review the images to identify suspicious findings, such as masses, abnormal
densities, microcalcifications, or architectural distortions. Mammography results are often
reported using the Breast Imaging Reporting and Data System (BI-RADS), which catego-
rizes findings into levels. If a mammogram is assigned BI-RADS 0, further evaluation,
such as additional imaging or a biopsy, is needed. Follow-up tests may be recommended
to confirm or rule out cancer, such as ultrasound, MRI, or a breast biopsy, depending on
the results and BI-RADS category.
When a mammographer examines a patient’s breast, she or he will put the breast on
the mammography machine’s plate and gently compress it with a second plate to spread
out the breast tissue so that the image may be taken. Each breast is X-rayed twice, once
from the top down (cranio-caudal view) and once from the side (mediolateral oblique
view), as is common protocol. If more views are required, that option is available.
Figure 3 shows how breast cancer on mammograms can vary depending on stage,
size, and location. Radiologists examine for abnormalities and patterns to detect breast
cancer. Common findings include masses, microcalcifications, architectural distortions,
asymmetries, spiculated borders, and nodules. Masses, microcalcifications, and architec-
tural distortions are early signs of breast cancer, while microcalcifications are tiny calcium
deposits in breast tissue. Figure 4 show the architectural distortions. These may appear as
irregularities in the breast’s structure, while asymmetries indicate differences in appear-
ance between the left and right breasts. Speciated borders, jagged or spiky edges, and
nodules are small rounded masses that are assessed for potential malignancy.
Diagnostics 2023, 13, 3113 13 of 21

Figure 3. Breast cancer mammography screening.

Figure 4. Breast cancer look on mammography.

Figure 5 demonstrates the various types of breast cancer percentages. We have a da-
taset with the following variables, cancer type (malignant or benign) and group of people
(young adults, middle-aged adults, and elders). Make a graph showing the distribution
of instances by age group, and whether they were malignant or not. We used a breast
cancer dataset including age- and diagnosis-related categories. Pandas are used to deter-
mine the proportion of instances in each age group for both malignant and benign diag-
noses. Finally, to prepare the data for the graph, a stacked bar graph is drawn to show the
distribution of cases by age and diagnosis. Age, gender, geography, and demographics
are only a few of the variables that might affect the breast cancer prevalence rate. Other
influences include one’s way of life, one’s genetic makeup, and one’s level of access to
medical treatment. According to the WHO, breast cancer is the most frequent cancer
among women worldwide. Case rates of breast cancer differ significantly across geo-
graphic locations. The proportion is often greater in affluent nations due to widespread
screening programs and public education efforts than in underdeveloped countries due
to scarcer resources and less awareness. For accurate and up-to-date data on breast cancer,
the American Cancer Society (ACS), the National Cancer Institute (NCI), the World Health
Organization (WHO), or other respected organizations are excellent resources.
Diagnostics 2023, 13, 3113 14 of 21

Figure 5. Breast cancer type percentages.

A dataset is partitioned into K equal-sized subgroups as part of the breast cancer

detection technique known as K-fold cross-validation. One of the K subsets is used as the
test set, while the other K-1 subsets are used for training. The model is trained and as-
sessed K times. To evaluate the model’s generalization to new data, performance
measures are computed on the test set. The performance indicators from each fold are
averaged after all K iterations to obtain a thorough analysis. Robustness, overfitting de-
tection, optimum hyperparameter tuning, bias and variance evaluation, and realistic per-
formance estimates all depend on K-fold cross-validation. It ensures that the assessment
is more reliable and less reliant on a certain data split, enabling more precise and accurate
forecasts of the model’s performance on new unseen data.
Breast cancer detection using machine learning: K-fold cross-validation ensures that
the chosen model’s performance is thoroughly assessed, helping one to build a reliable
and robust diagnostic tool. It is an essential step in the model development process to
ensure that the chosen system can provide accurate and consistent results on a variety of
patient data.
Figure 6 presents the best-ten correlation results between all variables. The values on
the y-axis include diagnosis, radius_mean testure_mean, perimeter_mean, area_mean,
smoothness_mean, etc. A correlation coefficient between −1 and 1 indicates no association
at all, whereas a positive or negative number indicates a strong relationship between the
two variables. It is important to note that the linear connection between variables is all
that can be measured using correlation. There is a link of 69% or higher between each of
these factors and the outlook for the patient.
Diagnostics 2023, 13, 3113 15 of 21

Figure 6. Correlation between the ten best variables.

Figure 7 presents the calculated correlations of diagnosis, radius_mean, tex-

ture_mean, etc. by absolute value. The diagnostic relationship between features will be
studied to test this idea. The vast majority of data is right-skewed, meaning that its right-
hand tail is much longer or fatter than its left-hand tail. This indicates that the mean is
higher than the median and that there are more observations of high values than low ones.
If the breast cancer dataset has a right-skewed distribution of characteristics, then the ma-
jority of patients will have smaller values for certain aspects, while a small percentage will
have larger values. This may suggest that the importance of some characteristics varies
with the kind of tumor being studied.
Diagnostics 2023, 13, 3113 16 of 21

Figure 7. Calculated correlations by absolute value.

Figure 8 presents the breast cancer diagnosis. In this figure, the color area indicates
the most that the most patients have lower values in some features and only a few have
very high values. The majority of the traits are strong concerning each other, as demon-
strated in the graphs. Additionally, compared to benign tumors, malignant tumors have
larger values for the same characteristics. Additionally, malignant tumor outliers exhibit
higher variation than benign tumor outliers and are better represented in clusters after
they have not been treated.

Figure 8. Breast cancer diagnosis graph.

Diagnostics 2023, 13, 3113 17 of 21

Most of the characteristics are rather robust in comparison to the other traits, as illus-
trated by the graphs. For the same characteristic, malignant tumors tend to have higher
values. In addition, after the extreme cases have been removed, data from malignant tu-
mors show higher variation than data for benign tumors. Most of the characteristics are
rather robust in comparison to the other traits, as illustrated. When comparing benign and
malignant tumors, the malignant tumor always has greater values for the same trait. Ad-
ditionally, data from malignant tumors, which are better represented in clusters due to
the absence of outliers, show higher variation.
Figure 9 shows 0 to 100%, and our highest accuracy is 96.49% by random forest. ML
has the potential to greatly improve the identification and diagnosis of breast cancer.
However, to successfully integrate technology into clinical practice, there are technologi-
cal, moral, and legal obstacles to overcome. The objective is to develop a more precise,
approachable, and patient-centric approach to breast cancer diagnosis and care as re-
search progresses and technology advances.
Figure 9 shows the accurate results of all classifiers that we used. This figure shows
the random forest as the best result which achieved 96.49% accuracy. The description of
others is given below.

Figure 9. Classifiers accuracy result.

• Random forest models have the highest accuracy values, indicating better perfor-
mance in predicting the target variable compared to other models.
• Decision tree and KNN have higher values than LG and SVC and are comparable to
other models, indicating that they may not be the best models for predicting the tar-
get variable.
• Logistic regression and SVC have similar values, indicating they have comparable
performance in predicting the target variable.
When it comes to detecting cancer, random forest may be a viable alternative because
of its versatility, ease of interpretation, and ability to determine which traits are most cru-
cial to the categorization decision-making process.
Figure 10 shows the graphical accuracy result of all classifiers. In this graph, we used
RF, DT, KNN SVC, LR, and linear SVC.
Diagnostics 2023, 13, 3113 18 of 21

Figure 10. Accuracy graph.

The selection of an algorithm for breast cancer diagnosis in the real world should
consider the unique needs of the clinical setting as well as the available computational
resources. The best method should be chosen based on factors including the size of the
dataset, hardware capabilities, and whether real-time or batch processing is required. The
computational efficiency of selected algorithms may also be increased via the use of par-
allelization and optimization methods, ensuring their viability and efficacy for clinical ap-
plications.
Figure 11 shows the predicted value of TP, FP, FN, and TN. In this confusion matrix,
each entry represents the number of occurrences that share a certain set of labels for both
the actual and expected classes. This confusion matrix, in particular, contains:
• Fifty (50) instances (True Positives)—malignant tumor classifications
• Two (2) instances (False Positives)—being tumors classified as malignant tumors
• Four (4) instances (False Negatives)—malignant tumors classified as benign tumors
• Forty-four (44) instances (True Negatives)—being tumors classifications

Figure 11. Predicted value.

Diagnostics 2023, 13, 3113 19 of 21

A large number of true positives and true negatives in the confusion matrix indicates
that the model has successfully predicted both groups. The model’s success may be seen
in its low rate of false positives and false negatives.

5. Conclusions and Future Work

This study examines six different categorization models for breast cancer classifica-
tion using the Breast Cancer Wisconsin (diagnostic) dataset. The data is processed using
the Standard Scaler module and feature selection is performed using Python’s scikit-learn
package. The models were developed using multimodal sets of machine learning algo-
rithms, including linear SVC, SVC, KNN, DT, RF, LR, DT, and logistic regression. The
study used a confusion matrix to compare anticipated outcomes with actual numbers and
assessed performance metrics such as accuracy, area under the precision, recall, sensitivity,
and f1-score. The results were summarized and compared using exploratory data analysis.
The study found that maximum area worst and maximum area_mean values decreased
after processing, potentially leading to false positives. The correlation between variables
in breast cancer diagnosis is crucial for understanding the relationship between features
and patient outlook. Random forest models have the highest accuracy values, followed by
decision tree and KNN. Logistic regression and SVC have similar performance in predict-
ing target variables. Random forest may be a viable alternative for detecting cancer due to
its versatility, ease of interpretation, and ability to identify crucial traits for categorization
decision-making. Breast cancer is a prevalent disease affecting women worldwide, with
machine-learning approaches potentially impacting early detection and prognosis. The
disease is classified into two subtypes: invasive ductal carcinoma (IDC) and ductal carci-
noma in situ (DCIS). Early detection is crucial for successful treatment, and appropriate
screening technologies are essential. Mammography, ultrasonography, and thermogra-
phy are common imaging modalities for detecting breast cancer. Advancements in artifi-
cial intelligence have made mammography more accurate, and deep learning models are
being developed to recognize breast cancer in computerized mammograms. Breast MRI
is a sensitive imaging technique with excellent sensitivity and specificity, and convolu-
tional neural networks and AI are emerging in healthcare to improve image processing
and reduce human eye recognition.
Future research on breast cancer diagnosis using ML might explore these and other
possibilities. To make substantial strides forward in the detection and treatment of breast
cancer, continued research and cooperation between data scientists, medical experts, and
researchers is essential.

Author Contributions: Conceptualization, A.K.; Methodology, G.S.C.; Software, A.M., H.A. and
G.S.C.; Formal analysis, G.S.C.; Resources, H.A. and G.S.C.; Data curation, B.F.A.; Writing—review
& editing, H.A. and G.S.C.; Project administration, F.A.; Funding acquisition, A.A. and H.A. All
authors have read and agreed to the published version of the manuscript.
Institutional Review Board Statement: Not applicable
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Funding: This research received no external funding.
Acknowledgments: This research was supported by the Researchers Supporting Project number
(RSP2023R244), King Saud University, Riyadh, Saudi Arabia.
Conflicts of Interest: The authors declare no conflict of interest.

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