Demographic Calibration Gaps in Breast Cancer Risk Prediction: Introducing the Demographic Calibration Gap Score
ABSTRACT: Most breast cancer prediction studies skip calibration reporting entirely. Fewer still examine calibration by demographic subgroup. Predicted probabilities that are systematically off for specific racial or gender groups produce biased clinical decisions, and aggregate statistics will not catch that. Objective: To introduce the Demographic Calibration Gap Score (DCGS), a metric that measures how much calibration error varies across demographic subgroups, and to show how it performs across five classifiers, four calibration conditions, and two datasets. Methods: Five classifiers were trained on the Wisconsin Diagnostic Breast Cancer dataset (n=569) and evaluated on a breast cancer cohort from MIMIC-IV (n=1,316). Three global calibration methods were applied: no calibration, Platt scaling, and isotonic regression. A fourth condition, subgroup-targeted Platt scaling, was applied to the MIMIC cohort. DCGS was computed as across racial and gender subgroups, with 95% bootstrap confidence intervals. Conformal prediction coverage and Demographic Coverage Gap (DCG) were reported. Results: On Wisconsin, all five models achieved AUROC above 0.98 and ECE below 0.12. Performance fell sharply on the MIMIC external cohort: AUROC dropped to 0.45-0.57 for base and globally calibrated variants, confirming distributional shift. DCGS exceeded the 0.05 clinical significance threshold in 28 of 40 model-calibration combinations on the race axis. Neither global Platt nor isotonic calibration reliably reduced DCGS below that threshold. Conformal coverage collapsed to roughly 25% on MIMIC, and racial DCG exceeded 0.15 for all 20 model-variant combinations. Conclusions: Reducing population-level ECE through global recalibration does not reliably close demographic calibration gaps. DCGS gives researchers a direct, standardized way to detect and report those disparities. Code and the DCGS computation library are released as open-source Python under the MIT License.