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A Comparative Analysis of Deep Learning Approaches for Predicting Breast

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Article in Archives of Computational Methods in Engineering · November 2021

DOI: 10.1007/s11831-021-09679-3

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Archives of Computational Methods in Engineering
https://doi.org/10.1007/s11831-021-09679-3

SURVEY ARTICLE

A Comparative Analysis of Deep Learning Approaches for Predicting

Breast Cancer Survivability
Surbhi Gupta1,2 · Manoj K. Gupta1

Received: 5 August 2021 / Accepted: 30 October 2021

© CIMNE, Barcelona, Spain 2021

Abstract
Breast cancer is the second largest cause of mortality among women. Breast cancer patients in developed nations have a
relative survival rate of more than 5-years due to early detection and treatment. Deep learning approaches can help enhance
the identification of breast cancer cells, lower the risk of detection mistakes, and minimize the time it takes to diagnose
breast cancer using human methods. This paper examines the accuracy of artificial neural networks, Restricted Boltzmann
Machine, Deep Autoencoders, and Convolutional Neural Networks (CNN) for post-operative survival analysis of breast
cancer patients. A thorough examination of each network's operation and design is carried out to determine which network
outperforms the other, followed by an analysis based on the network's prediction accurateness. The experimental results
assert that all the deep learning techniques can predict the survival of breast cancer patients. The accuracy score achieved
by Restricted Boltzmann Machine performed is the highest (0.97), followed by deep Autoencoders that attained an accuracy
score of 0.96. CNN achieved a 92% accuracy score, while artificial neural networks attained the least accuracy score (0.89).
The prediction performance of models has been evaluated using distinct parameters like accuracy, the area under the curve,
F1 Score, Matthew’s correlation coefficient, sensitivity, and specificity. Also, the models have been validated using fivefold
cross-validation techniques. However, there is still a need for complete analysis and research using deep learning methods
to determine the design that provides superior accuracy.

1 Introduction deployed screening method for detecting breast cancer

Breast cancer is the most commonly occurring malignancy
in females worldwide, with 606,520 fatalities estimated
in 2020 [1]. Breast carcinoma afflicts more than 2 million
women worldwide each year (24.2 per cent of all cancer
patients in 2018) [2]. Breast cancer is predicted to account
for 30% of all new cancer cases in women worldwide in
2020 [3]. Breast cancer is metastatic cancer that can spread
to other organs, making it incurable. An excellent progno-
sis and a high survival percentage can be achieved if the
diagnosis is made early. Mammography is a frequently
* Surbhi Gupta
sur7312@gmail.com
Manoj K. Gupta
manoj.gupta@smvdu.ac.in
1
School of Computer Science and Engineering, Shri
Mata Vaishno Devi University, Kakryal, Katra,
Jammu and Kashmir, India
2
Department of Computer Science and Engineering, Model
Institute of Engineering & Technology, Jammu, J&K, India
shown to reduce mortality significantly. Other detection
techniques have also been used and explored throughout the
previous decade. Several causes of cancer, including gender,
ageing, estrogens, genetic factors, genetic conditions, are
considered prime risk factors [4]. The mortality rates can be
reduced with early detection and better surgical procedures.
Biological therapy for breast cancer is effective [5].
Figure 1 shows the cancer statistics (estimated new cancer
cases) of 2020.
The term "survival" refers to how long a patient lives after
being diagnosed with an illness. Women with invasive breast
cancer have a 91 per cent 5-year survival rate [6]. If breast
cancer is detected entirely in the breast, women have a 99
per cent 5-year survival rate. 0.62 per cent of breast cancer
patients are diagnosed at this stage. This disparity could be
attributable in part to the screening delays experienced by
younger women. This emphasizes the need for early breast
cancer screening for a greater survival rate [7].
The healthcare system is an essential aspect of society
since it ensures that everyone receives proper diagnosis
and treatment. Leading to better treatment and prescription

13
Vol.:(0123456789)

Fig. 1  Cancer cases and deaths
in 2020
medications, it also reduces the requirement of skilled labor.
Integrating new technologies in healthcare has become vital
and inevitable in today's technologically advanced and fast-
paced environment. As a result, incorporating diverse tech-
nology in healthcare is a critical step in medical research
growth. The application of big data analysis to design sur-
vival prediction models became the latest research hotspot,
thanks to the influx of medical data and the advancement
of artificial intelligence [8]. However, automated learning
strategies can automatically learn data structures and do
not require any underlying assumptions. The deep learn-
ing approach can handle inter-dependence and non-linear
relationships among variables [9]. It excels at handling sig-
nificant complex higher-order interactions found in medical
data. As a result, machine/deep learning techniques have
much potential for everyday medical practice as central
healthcare technology systems. Diagnoses [10], illness pre-
diction models, recurrence predictions [11], and symptom
predictions [12, 13] have all benefited from ML research.
Furthermore, while the survival prediction grows over time,
there are significant differences in the databases, modelling
procedure, methodological quality, measures of perfor-
mance, and modelling of related potential predictors [14,
15].
This study intends to explore the performance of neural
Learning-based techniques to develop and validate the can-
cer survival prediction models. The predictive models have
been employed to predict breast cancer 5-year survival. The
5-year mark is critical for standardizing reporting and deter-
mining survivability. Many research works have employed
a 5-year criterion to determine survivability as it takes at
least five years to label a patient as alive or dead [16]. The
accuracy (acc.) of the distinct neural models in predicting
the 5-year survival rate for breast cancer hints towards estab-
lishing a better theoretical basis for applying machine learn-
ing/deep learning-based techniques in breast cancer survival
prediction [6]. Breast cancer is a complicated disease, and
assessing survivability becomes a significant focus of mod-
ern breast cancer research. The advancement of technology
13
S. Gupta, M. K. Gupta
aids in providing a more efficient and less time-consuming
diagnosis [17].
The remaining paper is organized as follows: Sect. 2 puts
forward the existing literature for the 5-year survival predic-
tion of breast cancer. Section 3 outlines the contributions of
this paper. Section 4 deliberates the materials and methods
explored in this work: data gathering, compilation, preproc-
essing, and deep neural networks. Section 5 highlights the
empirical analysis, simulation outcomes and comparison
with the existing literature. Section 6 discusses the study by
explaining the acquired results and comparing them. Finally,
the paper is concluded in the last section, along with the
further scope of enhancement.
2 Related Work
Existing research on the survival prediction of breast can-
cer patients is extensive. The clinical trials data, treatment,
and tumor-related information contribute to predicting the
5-year survival of a cancer patient. This section provides
the literature of existing works on the survival prediction of
breast cancer patients. People of all ages and health condi-
tions who have been diagnosed with breast cancer, including
those diagnosed very early and those diagnosed very late,
are included in the overall survival rate.
For survival analysis of breast cancer patients, a research
study conducted in 2008 [18] employed seven classifica-
tion techniques, i.e., Linear Regression; Artificial Neu-
ral Networks, Naive Bayes, Bayesian network; Decision
Trees + NB; Decision Trees and 37,256 cancer cases were
considered. The models evaluated using different parameters
performed well, and the highest acc (85.8%) was achieved
using logistic regression. Another study predicted the breast
cancer survival rate of 162 K cancer patients with an acc of
85% of using Fuzzy decision trees. Similar studies in 2009
[19] aimed to predict the breast cancer survival of 294 K and
182 K, respectively and the dataset was derived from the
SEER data repository. Choi 2009 [20] deployed Artificial
A Comparative Analysis of Deep Learning Approaches for Predicting Breast Cancer Survivability
Neural Networks; Bayesian network; Hybrid Bayesian
network for survival analysis and achieved an acc score of
88.8%. However, Liu 2009 [21] deployed decision trees for
the same purpose and achieved 79% acc. Decision Trees and
Linear Regression were also used in another study Wang,
2013 [22] to analyze the survival of breast cancer cases,
and after undersampling, decision trees achieved an 89.6%
acc score.
Kim, 2013 [23] and Park, 2013 [24] employed Support
Vector Classifier and Artificial Neural Networks on data of
cancer patients collected from SEER (1973–2003). These
studies affirmed the superior performance of neural networks
for survival prediction. Shin, 2014 [25] also analyzed the
same breast cancer data and used multiple learning tech-
niques like Decision Trees, Artificial Neural Networks, and
Support Vector Classifiers for constructing the prediction
model. This study inferred that semi-supervised learning
could predict the survival rate of breast cancer patients
with excellent efficiency and achieved an 81% area under
the curve (AUC) score. Also, Wang, 2014 [26] explored the
cancer data gathered during 1973–2007 and proposed learn-
ing techniques like linear Regression, Decision Trees, and
1-nearest neighbor for classifying cancer patients into differ-
ent risk groups and decision trees to achieve the highest acc
of 94%. Lotfnezhad, 2015 [7] used Support Vector Classi-
fier, Bayesian network, and Chi-squared Automatic Interac-
tion Detection on SEER breast cancer dataset (1999–2004).
This study advocated using support vector classifiers to esti-
mate breast cancer patient's survival, the acc achieved by
support vector classifiers was the highest, i.e., 97%. Shawky
2017 [27] explored four thousand cancer patient's data and
proposed multiple learning approaches like Artificial Neu-
ral Networks, KNN, Support Vector Classifier, and Linear
Regression for breast cancer survival prediction. The high-
est prediction acc was achieved using Artificial Neural Net-
works (91%). In 2019, two retrospective studies, Lu 2019
[28] and Abdikenov, 2019, intended to predict the survival
time of cancer patients. This study [28] employed a Genetic
algorithm, Extreme Learning Machine, Gradient Boosting,
and Multi-Layer Perceptron on a dataset of 82,707 patients
and achieved the highest acc score of 75%. Abdikenov, 2019
[29] explored the dataset of 659 K cancer cases and used
Deep Neural Networks, Linear Regression, Support Vector
Classifier, Random Forest, and Gradient Boosting technique
for classification of breast cancer patients into risk groups
and attained appreciable prediction outcomes (acc = 97%).
The studies affirmed the supremacy of machine-learning-
based techniques to predict breast cancer survival. Signifi-
cant research studies were conducted on the SEER breast
cancer dataset in 2010 [30] that employed multi-layer per-
ceptrons for the survival prediction of breast cancer patients.
Simsek, 2020 [31] used Artificial Neural Networks; Linear
Regression for breast cancer survival prediction. Salehi,
2020 [32] employed Multi-Layer Perceptron, Multi-Layer
Perceptron experts, and Multi-Layer Perceptron stacked gen-
eralization, whereas Hussain, 2020 [33] employed Artificial
Neural Networks, Decision Trees, and Linear Regression on
breast cancer dataset. All the studies have proposed auto-
mated learning approaches to predict breast cancer survival
rates and affirmed the superior performance of automated
learning techniques for breast cancer survival prediction.
The research studies that have proposed predictive models
using the SEER Breast cancer dataset have been analyzed
in Table 1.
Table 1 highlights the research analysis and the limita-
tions of the existing literature on the SEER Breast cancer
dataset. The existing literature is quite significant. Also, the
current research works that enable efficient survival predic-
tion mainly rely on convenient machine learning techniques,
and a few of the studies have evaluated neural network algo-
rithms. However, a scope of improvement in the field of sur-
vival prediction is there. The significant contributions made
in this work are highlighted in Sect. 3 as follows.
3 Contribution Outline
The study's main purpose is to evaluate the performance
of deep learning techniques and validate it on a fairly large
amount of data to analyze the 5-year survival analysis of
breast cancer patients. The contributions of the study are
stated below:
i. This paper provides a survey of research works that
performed the survival analysis of breast cancer using
SEER Breast cancer survival Dataset.
ii. Since the dataset is large-sized, deep learning algo-
rithms can significantly improve the survival predic-
tion outcomes compared to conventional machine
learning techniques applied throughout the literature.
The deep learning architectures/models, namely arti-
ficial neural networks, Restricted Boltzmann Machine,
Deep Autoencoders, and Convolutional Neural Net-
works (CNN) are employed for survival prediction
to enhance the prediction accuracy (ref. Section:
Results). Further, the study provides a comparative
analysis of multiple deep learning strategies.
iii. As depicted in Fig. 2, the proposed approach works
by gathering the breast cancer dataset by downloading
the data files from a trusted repository (https://​seer.​
cancer.​gov/) followed by preprocessing and conse-
quent survival prediction (based on five years) through
deep learning architectures. The proposed approach
has been validated using a fivefold cross-validation
technique.
13
 Table 1  Research analysis
Study Cases Features Analysis
13
Endo et al. [18] 37,256 10 The study employed multiple learn-
ing techniques like Linear regres-
sion, artificial neural networks,
NB, Bayesian network, decision
trees + NB, decision trees on
SEER breast cancer data collected
between 1972 and 1997
Khan et al. [19] 162,500 16 This study explored the fuzzy deci-
sion trees SEER Breast Cancer
Data collected between 1973–2003
Choi et al. [20] 294,275 14 Artificial neural networks, Bayes-
ian network, and Hybrid Bayesian
network was used for breast cancer
survival prediction using SEER
Breast cancer dataset (1973–2003)
Liu et al. [21] 182,517 16 This study employed decision trees
algorithm for survival prediction of
breast cancer patients registered in
SEER database during 1973–2004
Wang et al., 2013 [22] 215,221 9 The survival of breast cancer patients
was predicted using decision trees
and linear regression on the SEER
dataset recorded during 1973–2007
Kim et al. [23] 162,500 16 Support Vector Classifier and Artifi-
cial Neural Networks were used to
predict the survival of breast cancer
patients on the SEER Breast Cancer
dataset
Park et al. [24] 162,500 16 This study used Support Vec-
tor Classifier on SEER database
(1973–2003)
Shin et al. [25] 162,500 16 Three learning approaches, i.e.,
Decision Trees, Artificial Neural
Networks, and Support Vector
Classifier were used to predict the
survival analysis of breast cancer
using the SEER database from
1973 to 2003
Specifications
Missing values are not addressed;
nor is the feature section technique
described. No parameter tuning
feature section technique is not
described and no hyper parameter
tuning
feature section technique is not
described and no hyper parameter
tuning
no hyper parameter tuning
No hyper parameter tuning
Missing values are not addressed;
feature section technique is not
described and no hyper parameter
tuning
Missing values are not addressed;
feature section technique is not
described
Missing values are not addressed;
feature section technique is not
described
Limitations Results
The study can be extended by using Accuracy = 0.858
better feature selection technique
The complexity of the fuzzy decision Accuracy = 0.85
trees is high
Hybrid Bayesian network model has Accuracy = 0.88
higher complexity and takes more
processing time
The study can be extended using Accuracy = 0.79
ensemble or deep learning tech-
niques
The prediction accuracy can be Accuracy = 0.89
increased using deep learning
techniques
The accuracy achieved by the pro- Accuracy = 0.76
posed model is insignificant
Ther is scope to use more exhaustive Accuracy = 0.78
learning models to increase predic-
tion score
The study has not achieved signifi- Area Under the Curve = 0.81
cant accurateness
S. Gupta, M. K. Gupta
 Table 1  (continued)
Study Cases Features Analysis Specifications Limitations Results

Wang et al. [26] 215,221 5 Three machine-learning techniques, Missing values are not addressed; A very few numbers of predictors are Accuracy = 0.940
i.e., Linear Regression, Decision feature section technique is not used to train the models
Trees, and 1-nearest neighbor were described
used for the post-operative survival
prediction task. The dataset used by
the study was the SEER 1973–2007
breast cancer dataset
Lotfnezhad et al. [7] 22,763 18 This study explored the prediction Feature section technique is not This research work has explored Accuracy = 0.967
performance of Support Vec- described and no hyper parameter very few instances, a more detailed
tor Classifier, Bayesian network, tuning analysis on larger-sized data would
Chi-squared Automatic Interac- have provided better insights
tion Detection to forecast the life
expectancy of breast cancer patients
on SEER 1999–2004 dataset
Shawky et al. [27] 4490 14 This study explored Artificial Neural feature section technique is not The study needs to carry more Accuracy = 0.89
Networks, K-nearest neighbor, Sup- described and no hyper parameter exhaustive analysis to justify the
port Vector Classifier, and Linear tuning results
Regression to analyze the breast
cancer survivability on SEER 2010
dataset
Lu et al. [28] 82,707 14 Multiple learning approaches like feature section technique is not The prediction outcomes of study are Accuracy = 0.75
Genetic algorithm, Extreme Learn- described not significant enough
ing Machine, Gradient Boosting,
and Multi-Layer Perceptron were
employed to predict the breast
cancer survival. The dataset used
A Comparative Analysis of Deep Learning Approaches for Predicting Breast Cancer Survivability

by the study was SEER 1973–2014

Abdikenov et al. [29] 659,802 19
Fotouhi et al. [30] 26,092
Breast cancer dataset
Deep Neural Networks, Linear Missing values are not addressed; The study has not described the Accuracy = 0.96
Regression, Support Vector Classi- feature section technique is not procedure through which features
fier, Random Forest, and Gradient described are selected
Boosting classification algorithms
were used for the survival predic-
tion of breast cancer patients
17 This study used the algorithms like Missing values and hyper parameter The study can be improvised by car- Accuracy = 0.84
k-nearest neighbor, Multi-Layer tuning are not addressed rying an analysis of hybrid models
Perceptron, and Decision Trees for
breast cancer survival prediction on
SEER 1993–2014 dataset

13
 S. Gupta, M. K. Gupta

iv. As no state-of-the-art works describe compilation and

Accuracy = 0.84

Accuracy = 0.93
preprocessing of such a large amount of data (163,413
cancer cases), we have made available the python
code used for the preprocessing and for developing
the deep learning architecture to predict breast cancer
Accuracy = 0.75

survival: https://​github.​com/​surbh​igupt ​a24/​Breast-​

Cancer-​Survi​val-​Predi​ction.
Results

v. The features selected as the candidate predictors for

training the models have also been discussed and
The study has compared the proposed

comparison with other architectures

with enhanced learning strategies is

approved by the medical expert (oncologist) as the
would provide a fair comparative
Multi-Layer Perceptron architec-
ture with its own variants only; a
parameters used for building the

most important prediction indicators. Thus, the fea-

The evaluation of proposed study

The study has not described the

tures approved by the medical practitioner are used

for predicting the survival analysis of breast cancer
patients.
prediction modes

recommended
Limitations

analysis

4 Materials and Methods

The purpose of this article is to examine the performance

of deep learning classification algorithms for predicting
described and no hyper parameter
feature section technique and hyper
parameter tuning is not described

the survival rate of breast cancer patients. The procedure's

feature section technique is not

objective is to compare the efficacy of different strategies on

No hyper parameter tuning

cancer data sets. The python language is used on the Spyder

framework to develop all experiments. The workflow of the
study is depicted in Fig. 2.
The data collection and preprocessing is explained in
Specifications

the Sect. 4.1. In this study, we have used the data stand-
tuning

ardization as the information gathered includes features of

various dimensions and scales. The modelling of a dataset
is adversely affected by different sizes of data features. In
predict the breast cancer survival on
Perceptron stacked generalization to
for predicting the survival of breast

the life expectancy of breast cancer

cancer patients. The records of the

This study proposed different learn-

terms of misclassification error and accuracy rates, it leads

Networks and Linear Regression

ing architecture like Multi-Layer

patients were registered between

Linear Regression for predicting

patients. The data of the cancer

This study used Artificial Neural
This study used Artificial Neural

patients was collected between

Networks, Decision Trees, and

to a skewed outcome of predictions. As a result, the data

must be scaled before modelling as the input values in gen-
SEER 2004–2013 dataset

eral have different scales. Standardizing the dataset implies

transforming the distribution of values such that the mean
(µ) of observed values is 0 and the standard deviation(σ) is
1973 to 2001

1. Standardization is achieved using the equation (i).

1973–2013
Features Analysis

x−𝜇
Z= (1)
𝜎
After the data preprocessing, dataset is divided into 4:1
for training and testing. A 75% of data (122,559 records)
17

141,254 35

17

is used for training, and 25% of data instances (40,854) are

used to train the models. The data sets are classified using
90,308
53,732
Cases

distinct classification techniques, namely artificial neural

networks [35], Restricted Boltzmann Machine [36], Deep
Autoencoders [37], and Convolutional Neural Networks
Table 1  (continued)

Hussain et al. [33]

(CNN) [38]. The description of deep learning approaches

Simsek et al. [31]

Salehi et al. [32]

is elaborated in Sect. 4.2. In this study, we have used deep

learning algorithms for the survival prediction of breast can-
cer patients. The prediction performance of the model is val-
Study

idated using fivefold cross-validation [39]. The performance

13
A Comparative Analysis of Deep Learning Approaches for Predicting Breast Cancer Survivability
Fig. 2  Work flow of proposed
study
parameters used to evaluate the models are described in
Sect. 5.1.
4.1 Data Source
The Surveillance, Epidemiology, and End Results (SEER)
database is a dependable and valuable source that inte-
grates detailed data of patients, including cancer stage,
metastasis information, the patient's pathology, treatment
history, and the reason of death [16]. SEER, established
and preserved by the National Cancer Institute (NCI) of
the United States, is a reliable source of information on
cancer incidence and patient survival in the United States.
SEER collects data of the cancer patient. The National
Center for Health Statistics has reported death statistics
from SEER. The data sets, which span the years 1973 to
2014, contain 133 cancer-related characteristics and are
accessible via the SEER website at https://​seer.​cancer.​gov.
The Breast Cancer data set is utilized in the investiga-
tive study. SEER provided the raw data for this investiga-
tion, which include the breast cancer dataset. Data pre-
processing covers data cleansing, data integration, data
transformation, and data reduction in this study. However,
according to studies published in journals [30, 34], the
set of features is trimmed to 18. Table 2 summarizes the
description of the attributes used in the study.
13
 S. Gupta, M. K. Gupta

Table 2  Description of attributes

Feature Description

Marital status Defines the marital status of the patient at the time of tumor diagnosis
Race/ethnicity Describes the race/ethnicity of the patient
Sex Gender of the patient
Age at diagnosis Age of patient at the time of tumor diagnosis
Sequence number Keeps the record of tumors that arise during a patient's lifespan
Primary site Site in which tumor originated
Histologic type The microscopic constitution of cells associated with a specific primary
Behavior code Cancers are classified as benign /0, borderline /1, in situ /2 or malignant /3 according to ICD-O-3
Grade Extra codes indicating the presence of T-cells, B-cells, or null cells
Diagnostic confirmation Tests used for confirming the presence of a malignancy that has been reported
CS Tumor size Provides the details regarding tumor size
CS Extension Provides info regarding Extension of tumor
CS_Lymph_nodes briefs whether lymph nodes are involved or not
Regional_nodes (Positive) The actual amount of lymph nodes in the region inspected by the pathologist and found to contain metas-
tases
Regional_nodes (Examined) The pathologist inspected the actual amount of lymph nodes in the region and found them to contain
metastases
Reason_for_no_surgery The data element details the rationale for not performing surgery at the primary site
SEER_historic_stage It is a condensed version of the term "stage": in situ, localized, regional, remote, and unknown
First_malignant_primary_indicator Based on the total number of tumors in SEER. Tumors that have not been reported to SEER are presumed
to be malignant

4.2 Data Pre‑Processing
Pre-classification is done as per the suggestion of recent
studies. The categorization of survival (target column) is
shown in the Fig. 3 below.
Other situations, such as live patients with a survival
time of fewer than 60 months who die of a reason other
than that type of cancer, are excluded from this classifica-
tion. Following this stage, all other extraneous data associ-
ated with any record is removed. The remaining data sets
are corrected to include only 17 chosen features. After
these steps, 163,413 records were filtered out of 590,646
records, out of which 81,019 belong to the ‘alive’ cat-
egory, and 82,394 belong to the ‘not alive category used
for further analysis. Data is spliced randomly using the
‘train test split’ function.
4.3 Deep Learning Techniques
In this study, we have proposed to employ multiple deep
learning approaches to predict the survival of breast cancer
patients. The deep learning approaches used in the studies
are described below.
4.3.1 Artificial Neural Network (ANN) [40]
ANN is a neural/deep learning method derived from the Bio-
logical Neural Networks concept in the human brain. The

Pre-classification is done as per the suggestion of recent studies. The categorization of survival (target column) is shown in
the figure 3 below.
Step 1: If ((Survival_Months>=60) && (Vital_Status_Recode = alive))
Label Survival Status = ‘alive’
Step 2: Else if ((Survival_Months<60) && (Cause_of_Death= cancer))
Label Survival Status = ‘not survived’
Else
Step 3: Excluded from further analysis

Fig. 3  Artificial neural networks

13
A Comparative Analysis of Deep Learning Approaches for Predicting Breast Cancer Survivability

( )
creation of ANN was the outcome of an attempt to mimic
y[2] = q t
t [1]
+ b t [2]
= g [2] [2]
z5 (7)
the human brain's functions. The workings of ANN are pretty 5 5
⋅ 5 5

analogous to those of biological neural networks. However,

( )
they are not identical. The structure of an artificial neural net-
y[2] = qt6 ⋅ t[1] + b6 t6[2] = g[2] z[2] (8)
work is shown in Fig. 4. 6 6

The ANN algorithm accepts only numeric and structured

ANN can be used for both regression and classification
data. A perceptron is a neural network with only one layer,
applications by adjusting the activation functions of the out-
and Artificial Neural Networks are multi-layer perceptrons. A
put layers. For binary classification, use the sigmoid activa-
neural network can have distinct layers. One or more neurons
tion function; for multi-class classification, use the Softmax
or units can be found in each layer. Each neuron is connected
activation function; and for regression, use the linear acti-
to every other neuron in the system. Different activation func-
vation function. Since the target attribute, i.e., survival sta-
tions could be assigned to each layer. Forward propagation and
tus was a binary class problem; hence we used the sigmoid
back-propagation are the two phases of ANN. Hence, multipli-
activation function. The activation function, i.e., Sigmoid,
cation of weights and addition of bias followed by applying an
is described in the Eq. (9).
activation function to the inputs and propagating it forward is
the main task of forward propagation Each neuron in the layer 1
g(y) = (9)
(l) performs the calculation given in Eq. (2). 1 + e−y
( )
y[l] [l] [l] [l] The most crucial stage is backpropagation, which entails
(2)
t [l−1]
= q ⋅ a + b a = g zi
determining optimal parameters for the model by propagat-
k k i k

ing the neural network layers backwards. Backpropagation

The bi represents the bias term and t represents the activa-
requires an optimization function to discover the model's
tion function of the corresponding layer. For better understand-
ideal weights.
ing, the equation Eqs. (3), (4) represents the working for layer
2.
( ) 4.3.2 4.3.2 Convolutional Neural Network (CNN) [41]
y[2]
1
= qt1 ⋅ a[1] + b1 a[2]
1
= g[2] z[2]
1 (3)
A CNN differs from a traditional neural network as it func-
( ) tions over a volume of inputs. Each layer looks for a pattern
y[2]
2
= qt2 ⋅ t[1] + b2 t2[2] = g[2] z[2]
2 (4) or uses data in the data. Figure 5 presents the structure of a
Convolutional Neural Network.
( ) Each Conv layer is composed of numerous planes, allow-
y[2]
3
= q t
3
⋅ t [1]
+ b t
3 3
[2]
= g [2] [2]
z3 (5) ing for the construction of several feature maps at each point.
CNN model passes the kernel over the input; consequently,
( ) matrices are calculated using Eq. (10).
y[2] = qt4 ⋅ t[1] + b4 t4[2] = g[2] z[2] (6)
4 4 [ ] [ ] ∑∑ [ ] [ ]
Z x, y = (t ∗ w) x, y = w i, j t x − i, y − j
i j

tandwdenote the input (10)

[ ]
x, y is the [row,column] index of the resultant matrix

We have employed the CONV1D model for the survival

prediction of cancer patients. The activation function used
for constructing the model is sigmoid, while the 'Root
Mean Square Propagation' optimizer is used to optimize
the model. Also, we have used 20 epochs and a batch size
of 100 units to construct the model. A CNN receives text
as a sequence. The embedding layer receives the embed-
ding matrix as an argument. Each remark is subjected to five
various filter sizes, as well as GlobalMaxPooling1D layers.
Following that, all of the outputs are combined. A Dropout
layer is placed first, followed by a dense layer, followed by
another Dropout layer, and finally a Final Dense layer. We
Fig. 4  Artificial neural networks utilize a pooling layer between the convolutional layers to

13
 S. Gupta, M. K. Gupta

Fig. 5  Convolutional neural networks

( )
reduce dimensional complexity while still retaining the con- ( ) ∑
1
volutions' significant information. P vi = 1|Y = wij YJ + pi (11)
1 + e−x j

Restricted Boltzmann Machine [36]

4.3.3 
( )
( ) 1 ∑
The Boltzmann Machine is an unsupervised modelling P Yi = 1|Y = wij vi + qj (12)
1 + e−x
approach. This model generates a probabilistic model from i

a dataset and predicts new data instances. This model is

In the Eqs. (11) and (12), p and q represent the inter-
designed using an input layer (visible layer) and single or
cept vectors for the visible and hidden layers, respectively.
multiple hidden layers. The Boltzmann Machine uses neural
There is not any intra-layer connectivity between the nodes
networks in which neurons are connected to neurons at dif-
of the input and hidden layer. RBM is known as a Restricted
ferent levels and those in the same layer. Connections are
Boltzmann Machine because it restricts intra-layer connec-
bidirectional, with visible neurons and buried neurons both
tions. As RBMs are undirected, they do not use gradient
connected. The structure of a Restricted Boltzmann Machine
descent or backpropagation to alter their weights. Contras-
is given in Fig. 6.
tive divergence is the method through which they modify
RBM is an undirected, probabilistic, and generative
their weights. The distribution of weights for the nodes in
approach. RBM is also an asymmetrical bipartite graph since
the input layer is arbitrarily generated and utilized in the
it contains two layers: an input layer and a hidden layer.
hidden layer nodes at the initial stage.
Every visible node is linked to every hidden node. This
Further, the nodes in the hidden layer recreate visible
technique aims to identify the joint probability distribution
nodes throughout using the same weights. The created nodes
that intends to maximize the logarithmic-likelihood func-
are unidentical due to disconnection from one another. There
tion. The logistic sigmoid activation function of the input
is a symmetric bipartite graph in an RBM with no connec-
determines the conditional probability distribution of each
tions between units in the same group. Multiple RBMs can
unit, given in Eqs. (11) and (12).

Fig. 6  Restricted Boltzmann

machine

13
A Comparative Analysis of Deep Learning Approaches for Predicting Breast Cancer Survivability

be stacked and fine-tuned using gradient descent and back- computed using the 'binary_crossentropy' function. The
propagation algorithms. The RBM is a Stochastic Neural cross-entropy (CE) is computed using Eq. (13).
Network with two additional bias units (hidden bias and j
visible bias). The hidden bias RBM generates activation 1∑ ( ) ( )( ( ))
CE = Mi log Ki + 1 − Mi log 1 − Ki (13)
on the forward pass, whereas the visible bias aids RBM in j i=1
reconstructing the input on the backward pass. The regen-
erated input varies from the actual input since there are no The term Ki denotes the probability for i th instance and
connections between the units in the input/visible layer and Mi represents all the truth values for Jth instances. The acti-
hence no method of transmitting information between them. vation function used in the deep Autoencoders, i.e., ‘RELU’
is Eq. (13).
4.3.4 Deep Autoencoders [35] f (y) = max (0, y)(xiv) Here, y is the input. Also, we have
used the “Root Mean Square Propagation” optimizer to opti-
An autoencoder is made up of an encoder and decoder. The mize the algorithm. The RMSE score is calculated using
former compresses the input data, while the latter reverses Eq. (14).
the process to generate the uncompressed data, allowing for √
√ n
the most accurate reconstruction of the input. Autoencoder √∑ (𝛼i − 𝛽i )2
RMSE = √
architecture aims to construct an output layer representation i=1
n
of the input as close (similar) as feasible. On the other hand, (14)
𝛼1 , 𝛼2 , 𝛼3 , … 𝛼n are the predicted values
Autoencoders are used to determine a compressed version of
the input data with the slightest degree of data loss. Autoen- 𝛽1 , 𝛽2 , 𝛽3 , … 𝛽n are the observed values
coders operate similarly. The structure of a deep autoencoder ndenotes the number of observations
is given in Fig. 7, which depicts the input, hidden, and output
The disadvantage of this approach is that compressed data
layer in a deep autoencoder.
is that the organization of data in its compressed form cannot
The encoder component of the design compresses the
be determined. For proper clarification, the encoder does
input data, ensuring that vital information is preserved while
not eliminate some of the parameters; instead, it uses them
the total size of the data is significantly decreased. Dimen-
to generate the compressed version with fewer parameters.
sionality Reduction is the term for this notion. The loss is

Fig. 7  Deep autoencoders

13
 S. Gupta, M. K. Gupta

4.4 Validation [39] Table 3  Hardware and software specifications

Name Parameter
A five-fold cross-validation technique has been utilized to
validate classification results were compared objectively Operating system Windows 10, 64 bit
and avoid the generation of random outcomes. A cross- Processor Intel(R) Core i5-3230 M @
2.60 GHz, 2.60 GHz
validation is an approach for evaluating the prediction
RAM 8 GB
performance of automated learning techniques. Also, it
Programming LANGUAGE Python 3.6.9
demonstrates how to enlarge the machine learning model
Development environment Anaconda, Spyder Notebook
we have constructed into an individual data set.
As illustrated in Figs. 8, 5-fold Cross-Validation divides
the data into five sections. Each time, one of these five
subsets is used to validate, while the remaining four are 5.1 Evaluation Parameters
utilized to learn. This procedure is performed five times
more until all data has been used precisely once for learn- The performance of algorithms was measured on various
ing and once for validation. Finally, as a final estimate, parameters like acc, AUC score, Matthews correlation coef-
the average of the five times validation results is used [39, ficient (MCC), sensitivity score, specificity score, and F1 score
42, 43]. [44–46]. The description of evaluation parameters is given
below.
The confusion matrix functional evaluation metric is used
to assess the performance of these techniques. A confusion
5 Result Analysis matrix provides information about a classifier's actual and
expected classifications. A classifier's performance is often
All investigations were performed on a computer with evaluated using a confusion matrix based on the data. Table 4
a Windows 10 operating system and 8 GB of RAM, shows the confusion matrix.
and Python version 3.7 was used. Table 3 contains the In the Table 4, P stands for positive, N stands for negative,
detailed specifications. T stands for true, and F stands for false. Consequently, TP
stands for true positive, TN stands for true negative, FP stands
for false positive, and FN stands for false negative. Analyzing
and interpreting data is a necessary component of the evalua-
tion, and numerous evaluation methods are accessible. This is
to arrange and provide visible, understandable outcomes that
may be used and improved.

• Accuracy is the measurement parameter to determine the

effectiveness of a classifier. Accuracy is defined as the
number of correctly categorized values in a set and is cal-
culated using Eq. (15).
TP + TN
Accuracy = (15)
(TP + TN + FP + FN)
• The Receiver Operator Characteristic (ROC) curve is a
binary classification issue evaluation metric. A probability
curve displays the True-Positives against the False-Pos-
itives at different threshold values. The AUC score sum-
marizes the ROC curve that measures a model's ability to
classify instances.

Table 4  Confusion matrix P N

P TP FP
N FN TN
Fig. 8  5-Fold cross-validation

13
A Comparative Analysis of Deep Learning Approaches for Predicting Breast Cancer Survivability

• F1 score is calculated as the harmonic mean of precision Table 5  Accuracy of deep learning models
and recall. The F1 measure combines the characteristics K-Folds Artificial Convolutional Deep Restricted
of both metrics into a single value. The score is calcu- neural net- neural net- autoen- Boltzmann
lated using Eq. (16) to get the precision or recall values. works works coders machine

2 ∗ Precision ∗ Recall K=1 0.87 0.93 0.97 0.97

F1Score = (16) K=2 0.88 0.92 0.97 0.96
Precision + Recall
K=3 0.89 0.92 0.95 0.96
• Matthews’s correlation coefficient (MCC) measures the
K=4 0.9 0.94 0.96 0.97
quality of binary (two-class) classifications. It ranges K=5 0.885 0.91 0.96 0.98
between − 1 and + 1, where + 1 signifies a perfect pre- Average 0.885 0.924 0.962 0.968
diction and − 1 indicates total imperfection [47]. MCC
is calculated using Eq. (17).
(TP ∗ TN) − (FP ∗ FN) Table 6  AUC of deep learning models
MCC =
(TP + FP)(TP + FN)(TN + FP)(TN + FN)
(17) Models Artificial Convolutional Deep Restricted
neural net- neural net- autoen- Boltzmann
• A sensitivity/recall is calculated when a classifier divides works works coders machine
the true positives by the sum of true positives and false
K=1 0.87 0.92 0.97 0.98
negatives, as shown in Eq. 4. A high recall indicates that
K=2 0.88 0.93 0.97 0.97
the classifier is accurate and produces few false nega-
K=3 0.89 0.91 0.95 0.95
tives [44–46]. The sensitivity scores of the models are
K=4 0.9 0.94 0.96 0.98
calculated using Eq. (18).
K=5 0.885 0.9 0.96 0.96
TP Average 0.885 0.92 0.962 0.968
Sensitivity∕Recall = (18)
TP + FN
Bold indicates for each deep learning algorithm, the highest scores
• Specificity quantifies the proportion of negatives predic- achieved by the specific model
tions predicted correctly by a classifier. As seen in Eq. 5,
divides the number of true negatives by the sum of all 5.3 Comparison of AUC Scores of Prediction Models
true negatives and false positives. Specificity indicates
that the positive prediction is reliable, and the likelihood Table 6 shows the comparison of the deep learning tech-
of a false positive is low [44–46]. The specificity scores niques based on the AUC scores achieved.
of the models are calculated using Eq. (19). From Table 6, it can be inferred that Bernoulli RBM
fared the best, with a 97 per cent (approx.) AUC score,
TN
Specificity = (19) followed by Deep Autoencoders with a score of 96.2 per
TN + FP
cent AUC. Artificial neural networks had an AUC score
of 88 per cent, whereas convolutional neural networks had
an AUC score of 92 per cent. Thus, Bernoulli RBM was
5.2 Comparison of Accuracy Scores of Prediction the most accurate, whereas ANN was the least accurate.
Models

The deep learning models are compared on basis of predic-
tion accuracy obtained in Table 6. From Table 5, it is clear
that Bernoulli RBM performed the best attaining the high-
est accuracy, followed by Deep Autoencoders that attained
96.2% acc. Convolutional Neural networks achieved 92%
accurateness, whereas artificial neural networks attained an
89% acc score.
According to Table 5, based on the accurateness of mod-
els, the order of the models can be stated as Restricted Boltz-
mann Machine > Deep Autoencoders > Convolutional Neu-
ral Networks > Artificial Neural Networks. Hence, Bernoulli
RBM performed the best while ANN performed the worst
in terms of acc score.
5.4 Comparison of F1 Scores of Prediction Models
Table 7 illustrates the comparison between multiple learn-
ing approaches. The highest F1 scores achieved in each of
the folds are bold-faced.
Table 7 confirms that Bernoulli and Deep Autoencod-
ers performed better than other techniques and attained an
F1 score of 96.2 and 96 per cent (approx.), respectively.
Artificial neural networks achieved the least F1 score of
87 per cent, whereas convolutional neural networks had
an F1 score of 92 per cent. In terms of F1 score, Bernoulli
RBM outperformed the other three learning techniques.

13
 S. Gupta, M. K. Gupta

Table 7  F1 Score of deep learning models Table 9  Sensitivity score of deep learning models
Models Artificial neu- Convolutional Deep Restricted Models Artificial neu- Convolutional Deep Restricted
ral networks neural networks autoen- Boltzmann ral networks neural networks autoen- Boltzmann
coders Machine coders Machine

K=1 0.88 0.92 0.97 0.97 K=1 0.97 0.88 0.93 0.93
K=2 0.84 0.93 0.94 0.95 K=2 0.98 0.87 0.94 0.95
K=3 0.87 0.93 0.95 0.95 K=3 0.96 0.89 0.96 0.97
K=4 0.89 0.92 0.98 0.98 K=4 0.95 0.88 0.95 0.96
K=5 0.88 0.90 0.96 0.96 K=5 0.98 0.88 0.92 0.92
Average 0.872 0.92 0.96 0.962 Average 0.968 0.88 0.94 0.946

Bold indicates for each deep learning algorithm, the highest scores Bold indicates for each deep learning algorithm, the highest scores
achieved by the specific model achieved by the specific model

Table 8  MCC score of deep learning models Table 10  Specificity score of deep learning models
Models Artificial neu- Convolutional Deep Restricted Models Artificial neu- Convolutional Deep Restricted
ral networks neural networks autoen- Boltzmann ral networks neural networks autoen- Boltzmann
coders Machine coders Machine

K=1 0.79 0.88 0.94 0.95 K=1 0.82 0.88 0.98 0.99
K=2 0.77 0.89 0.93 0.94 K=2 0.81 0.84 0.99 0.98
K=3 0.77 0.91 0.93 0.95 K=3 0.78 0.88 0.96 0.96
K=4 0.78 0.88 0.9 0.95 K=4 0.8 0.87 0.98 0.99
K=5 0.79 0.89 0.92 0.9 K=5 0.8 0.88 0.98 0.98
Average 0.78 0.89 0.924 0.938 Average 0.802 0.87 0.978 0.98

Bold indicates for each deep learning algorithm, the highest scores Bold indicates for each deep learning algorithm, the highest scores
achieved by the specific model achieved by the specific model

5.5 Comparison of MCC Scores of Prediction Models
Table 8 depicts the comparison between multiple learning
approaches in terms of the MCC score obtained.
Table 8 verifies that Bernoulli RBM attained an MCC
score of 94 per cent (approx.). Deep Autoencoders attained
the MCC score of 92.4%, and convolutional neural networks
had an MCC score of 89.4 per cent. Artificial neural net-
works achieved the least MCC score of 78 per cent. In com-
parison to the other three learning approaches, Bernoulli
RBM demonstrated the best performance.
5.6 Comparison of Sensitivity Scores of Prediction
Models
The sensitivity/recall (Sens.) and specificity (Spec.) scores
obtained in each fold by the deep learning techniques are
summarized in Table 9.
Table 9 also demonstrates that Bernoulli RBM and Deep
Autoencoders attained a sensitivity score of 95% (approx.).
Convolutional neural networks had a sensitivity score of
97 per cent. Convolutional neural networks outperformed
the other three methods in terms of sensitivity. In terms
of sensitivity score, the Artificial Neural Networks have
achieved the highest sensitivity score, i.e., 96.8% (average),
the second-highest sensitivity score (94.6%) is achieved
using Deep Autoencoders.
5.7 Comparison of Specificity Scores of Prediction
Models
Table 10 shows a comparison of deep learning approaches
in terms of the attained specificity score.
Table 11 also shows that Bernoulli RBM attained the
highest specificity score, i.e., 98%. Deep Autoencoders had
a specificity score of 97.8 per cent, whereas Convolutional
Neural Networks had a specificity score of 89 per cent, and
artificial neural networks achieved the lowest specificity
score, i.e. 80%. In terms of specificity, Bernoulli RBM out-
performed the other three methods while artificial neural
networks underperformed. Analyzing the specificity scores,
we can rank Restricted Boltzmann Machine > Deep Autoen-
coders > Convolutional Neural Networks > Artificial Neural
Networks.
5.8 Comparison with Existing Studies
The proposed models have been compared to the previ-
ous studies based on the acc and AUC scores obtained by
the learning algorithms of the respective studies. Table 11

13
A Comparative Analysis of Deep Learning Approaches for Predicting Breast Cancer Survivability

Table 11  Comparison with Year Learning technique Accuracy

previous works
2008 [18] Logistic regression 0.858
2008 [19] Fuzzy decision trees 0.85
2009 [20] Hybrid Bayesian network 0.88
2011 [21] Decision Trees 0.79
2013 [22] Decision Trees, Linear REGRESSION 0.89
2013 [23] Semi-supervised Learning 0.76
2013 [24] Artificial neural networks 0.78
2014 [26] Decision Trees 0.940
2015 [7] Support vector classifier 0.967
2017 [27] Artificial neural networks 0.89
2019 [28] Genetic algorithm and Gradient Boosting 0.75
2019 [30] Multi-Layer perceptron 0.84
2020 [31] Artificial neural networks 0.75
2020 [32] Multi-Layer Perceptron stacked generalization 0.84
2020 [33] Decision Trees 0.93
Proposed study Restricted Boltzmann Machine 0.97
Deep autoencoders 0.962

Bold indicates for each deep learning algorithm, the highest scores achieved by the specific model

presents the comparative analysis of the proposed study with
previous works.
All the studies compared in Table 5 have explored the
same breast cancer dataset from the SEER repository. Also,
most the studies compared in Table 5 have employed deci-
sion trees. The highest accuracy achieved by the decision
trees is 94% [26]. Also, many of the studies have employed
artificial neural networks and multi-layer perceptron and
obtained the maximum of 89% prediction accurateness.
However, the deep learning model (Restricted Boltzmann
Machine) proposed in the current study have attained the
highest prediction outcomes (0.97) and have outperformed
the existing literature on breast cancer survival prediction.
6 Discussion
The number of cancer cases reported each year globally is on
the rise, and employing neural networks for cancer diagnosis
can help reduce this burden while also improving health-
care system efficiency. Advancements have been achieved
in understanding the survival rate of breast cancer in the last
decade. Consequently, the chances of survival are increased.
Because AI can perform several functions, including risk
assessment, diagnosis and detection, prognosis, and therapy
response, it is employed in cancer diagnosis. Because of its
vast variety of applications, AI in cancer detection is accept-
able and valuable. It has been analyzed that artificial neu-
ral network is the most frequently used automated learning
technique to predict breast cancer in the literature. Hence,
we have elected multiple neural techniques for breast cancer
survival prediction.
In this work, we executed deep learning techniques
using data from the SEER database of breast cancer inci-
dence after 2004. A dataset of 163,413 records with 18 fea-
tures was created after preprocessing 590,646 records with
109 features. The neural learning techniques employed in
this study are artificial neural networks, Restricted Boltz-
mann Machine, Deep Autoencoders, and Convolutional
Neural Networks. The performance of neural learning
architectures is validated using a fivefold cross-validation
technique. This study has multiple evaluation parameters
like accuracy, AUC, MCC, F1score, sensitivity, and speci-
ficity to evaluate models' performances. Also, most of the
studies have used different parameters to assess the perfor-
mance of the respective proposed models. Overall, all the
neural learning approaches performed well and predicted
the survival of breast cancer patients with good accurate-
ness. However, the simulation results also affirmed that
Restricted Boltzmann Machine, Deep Autoencoders, and
Convolutional Neural Networks performed better than arti-
ficial neural networks (which was proposed was most of
the recent studies). Also, another highlighting fact is that
Restricted Boltzmann Machine outperformed other learn-
ing architectures. Neural learning-based techniques have a
brighter future in relieving a single doctor of the strain of
examining thousands of patients. Various functions, proce-
dures, and training can all help to increase the efficiency of
this process. Neural architectures are self-learning systems
that can reduce errors over time while also reducing the
time required for diagnosis and categorization. Physicians

13

can use survivability prediction to help them determine the
optimal treatment option for a given patient. It can also
help patients avoid unnecessary treatments and operations
and the costs and adverse effects. Machine learning algo-
rithms for estimating cancer patient survivability produce
more accurate outcomes than human prediction. Conse-
quently, clinicians can use these predictors in addition to
their professional and clinical investigations to determine
the best course of treatment for their patients. Clinicians
can utilize the predictors to forecast tumor surgery and its
impact on a patient's survivability before the procedure.
7 Conclusion
The primary purpose of this research was to investigate
the performance of deep-based learning algorithms that
could predict breast cancer survival. This study presents an
elaborate experiment using multiple neural-learning tech-
niques for testing the SEER Breast cancer dataset. This
research analyses the prediction performance of distinct
deep learning approaches to predict the post-operative
life expectancy of breast cancer patients. The models
have been evaluated on real-time breast cancer patients
and validated using a fivefold cross-validation technique.
We have used multiple performance evaluation parameters
to ascertain the significant performance of the proposed
approaches.
Restricted Boltzmann Machine performed the best, and
Deep Autoencoders displayed the second-best performance
as per the accuracy, AUC, MCC, F1, and specificity scores.
In terms of sensitivity scores, Artificial Neural Networks,
followed by Deep Autoencoders, performed the best. Incor-
porating neural approaches in breast cancer diagnosis and
classification is critical to reducing the workload on doctors
who must diagnose multiple patients daily with improved
efficiency. The success of deep learning methods in predict-
ing breast cancer survival suggests that similar models could
be used in other prediction applications in the future. Fur-
thermore, using these predictors allows doctors to educate
their patients about their chances of surviving in the future.
Consequently, patients can make more informed decisions
about their lifestyle and treatment options in the future.
Hence, these techniques can be a cutting-edge tool in breast
cancer diagnosis and survival prediction that will benefit
patients and doctors.
Acknowledgements We express our gratitude to Dr. Rajeev Saini, MD,
DNB (Medical Oncology), Narayana Multispecialty Clinic, Jammu
& Kashmir (India), to provide us with consistent guidance on breast
cancer. Dr. Saini has also assisted in confirming that the prediction
indicators used in the study are extremely important from the medical
point of view.
13
S. Gupta, M. K. Gupta
Data Availability The datasets and Python code for data preprocessing
and constructing deep learning models is publicly available online on
Github (on request): https://​github.​com/​surbh​igupt​a24/​Breast-​Cancer-​
Survi​val-​Predi​ction
Declarations
Conflict of interests There is no conflict to be declared.
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