Mammograms are widely used as a frontline screening tool for breast cancer. New research now suggests they may also play a role in identifying cardiovascular risk. It is still the leading cause of death among women.
A study presented by researchers at the Penn State College of Medicine shows that calcium deposits visible in breast arteries on routine mammograms can help predict a woman’s future risk of heart attack, heart failure, stroke and all-cause mortality. The findings point to an underused source of cardiovascular insight embedded in imaging data that is already being collected at scale.
Arterial calcification
The condition, known as breast arterial calcification (BAC), appears in an estimated 15% to 25% of screening mammograms. Unlike calcifications linked to breast cancer, BAC is not routinely reported by radiologists because it has no known relevance for oncology. According to Matthew Nudy, assistant professor of medicine and public health sciences at Penn State, that practice may represent a missed opportunity. Particularly in women, who are often diagnosed with cardiovascular disease later than men.
Heart disease affects more than 60 million women in the United States and remains the number one cause of female mortality, according to the Centers for Disease Control and Prevention.
AI reveals progression and risk
In the study, researchers analyzed mammogram data from 10,348 women who underwent at least two screening exams, with an average interval of just over four years. An AI-based tool was used to automatically quantify the presence, severity and progression of arterial calcification across thousands of images, something that would be difficult and costly to achieve manually.
Nearly one in five women showed vascular calcification at baseline. More importantly, progression over time proved clinically meaningful. Women whose calcification worsened had significantly higher risks of major cardiovascular events, with those in the highest severity category facing up to double the risk. Even women who initially had no calcification but developed it later showed a 41% increased risk of cardiovascular events and death over follow-up. Notably, progression could be detected within a year, underscoring how dynamic cardiovascular risk can be.
No extra tests, no extra cost
Unlike coronary artery calcium scoring, which requires a dedicated CT scan, identifying BAC does not require additional imaging, radiation exposure or cost. The data are already present in routine mammograms performed for cancer screening.
If BAC were systematically reported, the next step would be cardiovascular risk assessment, not alarm. That typically includes blood pressure and cholesterol evaluation, risk calculators and, where appropriate, preventive interventions such as lifestyle modification or medication.
More equitable cardiovascular care
The findings may be especially relevant in addressing long-standing disparities in women’s heart health. Women are more likely to be diagnosed later and less likely to receive timely treatment. BAC could serve as an early, imaging-based signal to prompt further evaluation and prevention.
Standardization remains a challenge. There is currently no universally accepted reporting framework for BAC, although proposals exist. AI could play a key role here by enabling scalable, consistent and objective assessment.
Further studies, including ongoing work using data from the Women’s Health Initiative, aim to determine whether identifying BAC leads to meaningful changes in care and outcomes. For now, the research highlights how familiar imaging tools, augmented by AI, may help shift cardiovascular care toward earlier, more preventive intervention for women.
