If you’re over 40, you probably don’t need another reason to make sure you’re up to date with your mammograms. After all, they’re the gold standard for breast cancer screening.
But new research shows that your mammogram can tell you about more than just your cancer risk: It also inadvertently captures how much calcium is building up in breast arteries, a factor that influences your risk for heart disease.
“I think that there are some benefits of using a mammogram to get this added information because the mammogram is already being done for another purpose—it's being done for breast cancer screening,” says Matthew Nudy, MD, an assistant professor of medicine and public health sciences at Penn State College of Medicine and the lead author of the study. “So the benefit here is that we would be able to tap into data that is potentially already available to us and extract some additional information to help with cardiovascular risk.”
What is breast arterial calcification, and why does it matter?
When calcium builds up in the arteries, the blood vessels stiffen, restricting blood flow to the heart. Findings from previous research show a link between breast arterial calcification (BAC) levels pinpointed in routine mammograms and death from cardiovascular disease, such as a heart attack or stroke.
In Dr. Nudy’s study, researchers used AI to analyze data from over 10,000 women who had sequential mammograms—the average time between mammograms was about four years. Here is what they found:
- Over time, women with more BAC had a higher risk of a serious heart-related event.
- BAC was present on 19.4% of women’s first mammograms.
- Women who didn’t have BAC present at first had the lowest risk of BAC progression, but if it was detected on a follow-up mammogram, they had a 41% higher risk of a serious event or death from heart disease.
- Women who started with mild BAC on their first mammogram and progressed to moderate or severe BAC on a subsequent mammogram had a 59% higher risk of a serious or fatal cardiovascular event.
What does this mean for the average woman?
“It is highly feasible to incorporate BAC findings from routine mammograms into standard cardiovascular risk assessments,” says Stacey E. Rosen, MD, FAHA, the volunteer president of the American Heart Association, executive director of the Katz Institute for Women’s Health, and senior vice president of women’s health at Northwell Health in New York City. “The additional time required for radiologists to report BAC is minimal and does not significantly increase mammogram reading time.”
While the technology exists to assess BAC on routine mammograms, a formal policy that requires universal reporting of BAC does not. However, “there is a strong patient and physician preference for BAC to be reported and Northwell Health began universal reporting of BAC on all mammograms in 2024,” Dr. Rosen says. In fact, a study at Northwell Health found that direct patient notification about BAC after a mammogram led to more than half (57.1%) of patients discussing the results with a primary care physician or cardiologist.
“If women are concerned about their cardiovascular disease risk and have a mammogram coming up, they should discuss these concerns and any potential BAC findings with their primary care physician or a cardiologist,” Dr. Rosen advises. “Be aware that if BAC is detected on their mammogram, this information can serve as a starting point for cardiovascular screening and preventive discussions with their healthcare clinicians.”
What else can you do to stay on top of your cardiovascular health?
Detecting BAC on a mammogram is one cardiovascular risk assessment that can help women learn more about their heart health and manage their risk. These opportunities to assess women’s cardiovascular risk are crucial because of gender-based disparities in heart health, Dr. Nudy explains.
“We know that women are less likely to be diagnosed or less likely to receive guideline-directed medical therapy for cardiovascular disease compared to men,” Dr. Nudy says. “They're more likely to be diagnosed at later stages of cardiovascular disease compared to men, and they're known to have a worse prognosis following a heart attack compared to men. And we think part of these disparities are being driven by inadequate cardiovascular risk assessment.”
Fortunately, there are actions women can take to close these gaps. “The great news is that 80% of heart disease and stroke is preventable,” says Dr. Rosen. She recommends following Life’s Essential 8, the key measures for improving and maintaining cardiovascular health, as defined by the American Heart Association. These measures include:
Health Behaviors:
- Eat Healthier
- Be More Active
- Quit Tobacco
- Get Enough High-Quality Sleep
Health Factors to Manage:
- Cholesterol
- Blood Pressure
- Blood Glucose
- Weight
The bottom line
Your mammogram can do more for you than catch breast cancer early: It can also offer a window into your heart health. If you’re over 40 and getting mammograms, ask your doctor whether your BAC level is being reported and how those findings might factor into managing your overall health.
