Viewpoint on the Consequences and Mitigation of Cognitive Bias in the Radiological Interpretation of Breast Cancer Imaging Using Artificial Intelligence

Abstract

Unlabelled: Artificial intelligence (AI) is increasingly integrated into breast imaging workflows, offering the potential to enhance diagnostic accuracy, efficiency, and early cancer detection. Image interpretation plays a pivotal role in the breast cancer diagnostic pathway, directly influencing therapeutic decisions and patient outcomes. However, the effective implementation of AI-assisted systems relies not only on technical performance but also on radiologists' trust, acceptance, and readiness to incorporate these tools into clinical practice. In addition, system-related, perceptual, and cognitive factors may contribute to diagnostic errors, ultimately affecting overall accuracy and reliability. This paper provides a comprehensive overview of the cognitive and systemic sources of diagnostic inaccuracies in breast imaging, emphasizing the growing role of AI as both a supportive and potentially bias-modulating tool. Recent prospective studies have demonstrated the clinical safety and effectiveness of AI-assisted mammography screening, reporting improved cancer detection rates and reduced workload. Nonetheless, the integration of AI into diagnostic workflows without an appropriate knowledge of the consequences may introduce new cognitive biases, such as anchoring, automation, and confirmation bias, that influence radiologists' decision-making and counteract the intended benefits. To address these challenges, the paper outlines strategies to mitigate diagnostic errors and foster appropriate integration of AI into clinical practice. These include targeted training programs, enhanced interdisciplinary communication, and standardized interpretation workflows that promote consistent evidence-based practice. Furthermore, the adoption of explainable AI approaches is identified as a key factor in improving model transparency and interpretability, allowing radiologists to understand algorithmic reasoning and engage in a more informed, confidence-based human-AI collaboration. Ultimately, a balanced and context-sensitive integration of AI, grounded in continuous professional education and cognitive awareness, is essential for improving diagnostic accuracy while preserving radiologists' critical analytical skills.

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