New research suggests routine mammograms could do double duty, spotting not only breast cancer but also early warning signs of cardiovascular disease in women. Calcium in breast arteries, visible on X-ray images, may help doctors better predict who is most at risk.
Routine mammograms are best known for saving lives by catching breast cancer early. New research suggests they could also offer a powerful, underused window into women’s heart health.
A team led by Matthew Nudy, assistant professor of medicine and public health sciences at Penn State College of Medicine, has found that calcium buildup in the arteries of the breast, visible on standard mammogram images, predicts a woman’s future risk of major cardiovascular problems such as heart attack, stroke, heart failure and death.
The work, presented Dec. 3 at the Radiological Society of North America meeting, adds to growing evidence that mammograms may be able to pull double duty: screening for breast cancer while also flagging women at high risk for the leading cause of death in adults.
As people age, calcium can collect in artery walls, making blood vessels stiffer and raising the risk of heart attack and stroke. Doctors sometimes order a CT scan to look for calcium in the coronary arteries that feed the heart, but that test adds cost and radiation exposure and is not routinely done for everyone.
Mammograms, by contrast, are already recommended every one to two years for most women starting at age 40 by groups such as the American Cancer Society and the U.S. Preventive Services Task Force. These X-ray images can also show calcium deposits in the arteries of the breast, known as breast arterial calcification. Today, those findings are usually ignored in radiology reports because they are not linked to breast cancer.
Nudy and his colleagues wanted to know whether the amount and progression of this breast arterial calcification could serve as a warning sign for cardiovascular disease.
“We know that women are more likely to be diagnosed at later stages of cardiovascular disease and have worse outcomes following a heart attack compared to men. That may be in part because the current cardiovascular risk assessment tools underestimate risk in women. We need better tools,” Nudy said in a news release.
To explore that possibility, the team conducted an observational study using data from 10,348 women treated at an academic medical center in the United States. All had at least two mammograms, with an average of 4.1 years between scans. The average age was 56.
For each mammogram, the researchers used an investigational version of cmAngio, an artificial intelligence software developed by the medical imaging company CureMetrix, to automatically detect whether calcium was present in the breast arteries and to estimate how severe it was. The software generated a score based on the length of the calcified segments.
The women were then grouped into four age-adjusted categories of breast arterial calcification severity: negative, mild, moderate and severe.
At the first mammogram, vascular calcification was present in 19.4% of participants. Women with more calcium in their breast arteries had a higher risk of serious cardiovascular events in the years that followed. Those in the severe category had up to twice the risk of a major heart-related event compared with women with no detectable calcification.
The study is among the first to track how breast arterial calcification changes over time and link that progression to outcomes. The researchers found that calcification can worsen in as little as a year, and that faster progression was tied to greater cardiovascular risk.
Women who had no breast arterial calcium on their initial mammogram had the lowest chance of progression. But if calcium appeared on a later mammogram, their risk of an adverse cardiovascular event or death rose by 41% over an average of 5.6 years of follow-up.
Risk climbed even more steeply for women who already had some calcification and then worsened. Those who started in the mild category and progressed to any higher category had a 59% higher risk. Women who moved from moderate to severe calcification had a 93% higher risk.
These patterns suggest that both the presence and the worsening of breast arterial calcification could help identify women who are most vulnerable to future cardiovascular disease.
In the long run, this information could be folded into routine care without adding new tests, simply by paying attention to data that mammograms already capture, according to Nudy.
“This could be a way to use data that may already be available for different reason and to potentially use it to risk stratify an individual for the development of cardiovascular disease,” Nudy added.
He also emphasized that the work is still early. While the findings point to breast arterial calcification as a promising marker of cardiovascular risk, more research is needed to understand exactly how doctors should use this information and whether acting on it can improve outcomes.
“In the future, assessment of breast arterial calcification may help improve our ability to predict risk and prevent cardiovascular disease,” added Nudy.
That could be especially important for women, who often have their heart disease risk underestimated by current tools and may not receive aggressive prevention until after symptoms appear. If mammograms can reliably flag higher-risk patients years earlier, clinicians might be able to intervene sooner with lifestyle changes, medications or closer monitoring.
The study builds on previous research, including a systematic review and meta-analysis led by Nudy, that has linked breast arterial calcification to later cardiovascular disease and death. It also highlights the growing role of artificial intelligence in medical imaging, where software can sift through thousands of scans to find subtle patterns that humans might miss or not routinely measure.
Other collaborators on the project included researchers from Monash University’s Victorian Heart Institute, the University of Southern California and CureMetrix. The study underwent double-blind peer review as part of the Radiological Society of North America meeting process and was supported by CureMetrix.
For now, the research does not change mammography guidelines, and patients should continue to follow their doctors’ recommendations for breast cancer screening and heart health. But it points toward a future where a single, familiar test could quietly pull double duty, helping protect women from two of the most serious threats to their health.
Source: Pennsylvania State University