The application of artificial intelligence (AI) in healthcare has tremendous potential for improving diagnostic precision and optimizing treatment and patient care. However, increasing dependence on such tools brings up urgent questions regarding the amplification of existing biases, which may detract from their ability to improve fair clinical decision-making. Adversarial debiasing, a method that utilizes fairness measures by contrasting a core predictive model with an adversarial network to reduce the influence of sensitive features, has emerged as an effective way of mitigating bias in AI systems. This review combines findings from 25 studies on several areas, encompassing the technical elements of adversarial learning and its practical applications in healthcare. The review offers extensive data and thoroughly assesses technological, ethical, and practical issues. This study reveals that adversarial debiasing improves fairness indicators and presents significant trade-offs, including reduced sensitivity and interpretability. We conclude with recommendations for future research avenues, encompassing prospective multicenter trials, adaptive training methodologies, hybrid debiasing strategies, and formulating standardized regulatory frameworks.
Cite this paper
Waithira, J. , Chweya, R. and Cyprian, R. M. (2025). Adversarial Debiasing for Bias Mitigation in Healthcare AI Systems: A Literature Review. Open Access Library Journal, 12, e3340. doi: http://dx.doi.org/10.4236/oalib.1113340.
Secinaro, S., Calandra, D., Secinaro, A., Muthurangu, V. and Biancone, P. (2021) The Role of Artificial Intelligence in Healthcare: A Structured Literature Review. BMC Medical Informatics and Decision Making, 21, Article No. 125. https://doi.org/10.1186/s12911-021-01488-9
Hurlbert, M. (2025) Improving AI Performance for People of Color: Diagnosing Melanoma & Other Skin Cancers. Melanoma Research Alliance. https://www.curemelanoma.org/blog/making-ai-work-for-people-of-color-diagnosing-melanoma-and-other-skin-cancers
Jemielity, S. (2025) Health Care Prediction Algorithm Biased against Black Patients, Study Finds. University of Chicago News. https://news.uchicago.edu/story/health-care-prediction-algorithm-biased-against-black-patients-study-finds
Rama-dass, S., Narayanan, S., Kumar, R. and K, T. (2024) Effectiveness of Generative Adversarial Networks in Denoising Medical Imaging (CT/MRI Images). Multimedia Tools and Applications. https://doi.org/10.1007/s11042-024-20130-0
Zheng, G., Jacobs, M.A., Braverman, V. and Parekh, V.S. (2025) To-wards Fair Medical AI: Adversarial Debiasing of 3D CT Foundation Embeddings. arXiv: 2502.04386.http://arxiv.org/abs/2502.04386
Char, D.S., Shah, N.H. and Magnus, D. (2018) Imple-menting Machine Learning in Health Care—Addressing Ethical Challenges. New England Journal of Medicine, 378, 981-983. https://doi.org/10.1056/nejmp1714229
Mehrabi, N., Morstatter, F., Saxena, N., Lerman, K. and Galstyan, A. (2021) A Survey on Bias and Fairness in Machine Learning. ACM Computing Surveys, 54, 1-35. https://doi.org/10.1145/3457607
Obermeyer, Z., Powers, B., Vogeli, C. and Mullainathan, S. (2019) Dissecting Racial Bias in an Algorithm Used to Manage the Health of Populations. Science, 366, 447-453. https://doi.org/10.1126/science.aax2342
Rajkomar, A., Hardt, M., Howell, M.D., Corrado, G. and Chin, M.H. (2018) Ensuring Fairness in Machine Learning to Advance Health Equity. Annals of Internal Medicine, 169, 866-872. https://doi.org/10.7326/m18-1990
Suresh, H. and Guttag, J. (2021) A Framework for Understanding Sources of Harm Throughout the Machine Learning Life Cycle. Equity and Access in Algorithms, Mechanisms, and Optimization, 5-9 October 2021, 1-9. https://doi.org/10.1145/3465416.3483305
Zhang, B.H., Lemoine, B. and Mitchell, M. (2018) Mitigating Unwanted Biases with Adversarial Learning. Proceedings of the 2018 AAAI/ACM Conference on AI, Ethics, and Society, New Orleans, 2-3 February 2018, 335-340. https://doi.org/10.1145/3278721.3278779
Chen, I.Y., Szolovits, P. and Ghassemi, M. (2019) Can AI Help Reduce Disparities in General Medical and Mental Health Care? AMA Journal of Ethics, 21, 167-179.
Esteva, A., Kuprel, B., Novoa, R.A., Ko, J., Swetter, S.M., Blau, H.M., et al. (2017) Der-matologist-level Classification of Skin Cancer with Deep Neural Networks. Nature, 542, 115-118. https://doi.org/10.1038/nature21056
Gulshan, V., Peng, L., Coram, M., Stumpe, M.C., Wu, D., Narayanaswamy, A., et al. (2016) Development and Validation of a Deep Learning Algorithm for Detection of Diabetic Retinopathy in Retinal Fun-dus Photographs. JAMA, 316, 2402-2410. https://doi.org/10.1001/jama.2016.17216
Arjovsky, M., Chintala, S. and Bottou, L. (2017) Wasserstein Generative Adversarial Networks. Proceedings of the 34th International Conference on Ma-chine Learning, Sydney, 6-11 August 2017, 214-223.
Hardt, M., Price, E. and Srebro, N. (2016) Equality of Oppor-tunity in Supervised Learning. Proceedings of the 30th International Conference on Neural Information Processing Systems, Barcelona, 5-10 December 2016, 3323-3331.
Buolamwini, J. and Gebru, T. (2018) Gender Shades: Intersectional Accuracy Disparities in Commercial Gender Classification. Proceedings of the 1st Conference on Fairness, Accountability and Transparency, New York, 23-24 February 2018, 77-91.
Selbst, A.D., Boyd, D., Friedler, S.A., Venkatasubramanian, S. and Ver-tesi, J. (2019) Fairness and Abstraction in Sociotechnical Systems. Proceedings of the Conference on Fairness, Accountabil-ity, and Transparency, Atlanta, 29-31 January 2019, 59-68. https://doi.org/10.1145/3287560.3287598
Kearns, M., Neel, S., Roth, A. and Wu, Z.S. (2018) Preventing Fairness Gerrymandering: Auditing and Learning for Subgroup Fairness. Proceedings of the 35th International Conference on Machine Learning, Stockholm, 10-15 July 2018, 2564-2572.
Kelly, C.J., Karthikesalingam, A., Suleyman, M., Corrado, G. and King, D. (2019) Key Challenges for Delivering Clinical Impact with Artificial Intelligence. BMC Medicine, 17, Article No. 195. https://doi.org/10.1186/s12916-019-1426-2
Wiens, J., Saria, S., Sendak, M., Ghassemi, M., Liu, V.X., Doshi-Velez, F., et al. (2019) Do No Harm: A Roadmap for Responsible Machine Learning for Health Care. Nature Medicine, 25, 1337-1340. https://doi.org/10.1038/s41591-019-0548-6
Rajpurkar, P., Irvin, J., Ball, R.L., Zhu, K., Yang, B., Mehta, H., et al. (2018) Deep Learning for Chest Radiograph Diagnosis: A Retrospective Comparison of the Chexnext Algorithm to Practicing Radiologists. PLOS Medicine, 15, e1002686. https://doi.org/10.1371/journal.pmed.1002686
Topol, E.J. (2019) High-Performance Medicine: The Convergence of Human and Artificial Intelligence. Nature Medicine, 25, 44-56. https://doi.org/10.1038/s41591-018-0300-7