Every year, tens of millions of women get a mammogram for one reason: to screen for breast cancer. But a growing body of research suggests these same images may be quietly revealing something else. A woman’s risk of heart disease.
Breast Arterial Calcification
Breast arterial calcification (BAC) is a small deposit of calcium in the walls of the tiny arteries that run through breast tissue. Radiologists have seen it on mammograms for decades, usually noting it in passing without much clinical follow-up.
That may be changing. BAC isn’t the same as the plaque buildup that clogs coronary arteries. It’s calcification in the middle layer of the artery wall. This process is linked to arterial stiffening rather than narrowing. But mounting evidence shows it’s still a meaningful warning sign as women with BAC face a higher risk of heart attack, stroke, heart failure, and death from cardiovascular causes.
What the Research Shows
The evidence has been building steadily:
- A 2022 American Heart Association-backed study of over 5,000 postmenopausal women found those with BAC had a 51% higher risk for heart disease and stroke than women without it.
- A 2023 Dartmouth study following women for a decade found twice as many women with BAC experienced a major cardiovascular event within 10 years compared to those with no calcification.
- Most recently, new research from Penn State presented at the Radiological Society of North America meeting showed that women with more severe calcification, and those whose calcification worsened over time, faced significantly higher risk of major cardiovascular events, including heart attack, stroke, heart failure, and death.
Why This Matters So Much for Women
Standard cardiovascular risk calculators are tools built around cholesterol, blood pressure, smoking status, and age, but they tend to underestimate risk in women. Particularly those with atypical symptoms or nontraditional risk factors. That gap in risk prediction may help explain why women are so often diagnosed with heart disease later, and with worse outcomes, than men.
BAC offers something those calculators don’t: a direct, physical look at a woman’s arteries, captured incidentally during a test that tens of millions of women already get. As one researcher behind the Penn State study put it, this could help identify women who are at greatest risk for cardiovascular disease, at a time when better risk tools are badly needed.
The Practical Hurdle: Someone Has to Look
The technology to detect coronary artery calcium already exists: a cardiac CT scan. But it comes with costs and radiation exposure that make it a hard sell for routine, preventive use. Mammograms, by contrast, are already part of most women’s healthcare routine, at no extra cost or radiation burden.
The catch is that BAC is easy to miss. It isn’t part of standard mammogram reporting, and it remains underreported due to a lack of standardized guidelines and limited awareness among providers. That’s starting to change, partly thanks to artificial intelligence. Newer, experimental softwares can detect and quantify calcification on a mammogram, flagging it consistently rather than leaving it to chance.
What This Means for Patients
BAC isn’t yet part of official cardiovascular risk guidelines, and a mammogram isn’t a replacement for blood pressure checks, cholesterol tests, or a conversation with a doctor about heart disease risk. But the research points toward a future where a single test and one already built into routine care could serve double duty, catching early warning signs of two of women’s biggest health threats at once.
More research is needed to understand the relationship between mammograms and BAC, and to determine how clinicians can integrate this into their practice. For now, women who learn their mammogram noted arterial calcification have a good reason to bring it up with their doctor, rather than let it go unmentioned in the chart.
Resources
- Mammograms may provide clues about women’s risk for cardiovascular disease- American Heart Association Newsroom
- Mammograms show promise as tool for predicting heart disease and stroke in women- American Heart Association Newsroom
- Calcium in breast arteries predicts future cardiovascular disease- Penn State Health News