Is ChatGPT-5 Ready for Mammogram VQA?

Abstract

Mammogram visual question answering (VQA) integrates image interpretation with clinical reasoning and has potential to support breast cancer screening. We systematically evaluated the GPT-5 family and GPT-4o model on four public mammography datasets (EMBED, InBreast, CMMD, CBIS-DDSM) for BI-RADS assessment, abnormality detection, and malignancy classification tasks. GPT-5 consistently was the best performing model but lagged behind both human experts and domain-specific fine-tuned models. On EMBED, GPT-5 achieved the highest scores among GPT variants in density (56.8%), distortion (52.5%), mass (64.5%), calcification (63.5%), and malignancy (52.8%) classification. On InBreast, it attained 36.9% BI-RADS accuracy, 45.9% abnormality detection, and 35.0% malignancy classification. On CMMD, GPT-5 reached 32.3% abnormality detection and 55.0% malignancy accuracy. On CBIS-DDSM, it achieved 69.3% BI-RADS accuracy, 66.0% abnormality detection, and 58.2% malignancy accuracy. Compared with human expert estimations, GPT-5 exhibited lower sensitivity (63.5%) and specificity (52.3%). While GPT-5 exhibits promising capabilities for screening tasks, its performance remains insufficient for high-stakes clinical imaging applications without targeted domain adaptation and optimization. However, the tremendous improvements in performance from GPT-4o to GPT-5 show a promising trend in the potential for general large language models (LLMs) to assist with mammography VQA tasks.