Mammograms May Also Flag a Woman’s Heart Disease Risk

A woman in her 50s goes in for her yearly mammogram and learns she does not have breast cancer. But the scan may also show calcium deposits in the arteries of her breast tissue, an indicator of possible future heart attack or stroke. Because radiologists are not required to examine that measure, the warning can go unnoticed.

She leaves relieved, never realizing the scan may have revealed an early sign of a condition that could pose an even greater threat to her life.

The finding is known as breast arterial calcification, or BAC. It already appears on the millions of mammograms done each year in the United States, and spotting it does not require extra cost or added reading time. Yet heart disease kills more American women than all cancers combined, and the people who could act on BAC — radiologists, primary care doctors and cardiologists — rarely coordinate care.

At present, no country requires BAC to be reported, and there are no standard follow-up pathways once it is detected. That leaves a major missed chance to improve individualized risk assessment and begin cardiovascular prevention earlier. Too often, a woman’s care in midlife depends on where she lives, whom she sees or how her clinician was trained, instead of a uniform evidence-based standard.

That broken system should be fixed. Clear reporting standards for BAC, along with protocols clinicians can follow when it is found, would help create a more integrated approach to women’s midlife health.

Some health systems have already shown that BAC reporting can be put into practice. Northwell Health has reported BAC across its 21 hospitals since 2024. At Mount Sinai, radiology and cardiology teams work together to measure how common BAC is and to define the best way to report it to patients.

The possible impact is substantial. In a Stanford study, clinicians and patients who were told about coronary artery calcification seen on scans were more likely to act on the information than those receiving usual care; statin use, for example, rose significantly. The McKinsey Health Institute estimates that preventive care triggered by BAC risk findings would cost about $500 per woman and could avert an estimated 17,000 to 60,000 cardiovascular events in the United States over seven years, saving billions in health care spending.

Making BAC reporting routine does not require a political breakthrough. The breast cancer community already showed the way. A few years ago, the FDA updated mammography rules to require that women be told about breast density, since dense breast tissue can make cancer harder to detect. That change came through sustained work by patient advocates, including the late Dr. Nancy Cappello and JoAnn Pushkin, along with groups such as Susan G. Komen, state lawmakers, bipartisan congressional allies like Rep. Rosa DeLauro and the late Sen. Dianne Feinstein, and the FDA.

In the same spirit, the people with the ability to standardize BAC reporting can work together to make it the norm.

Radiologists and their professional organizations should set clear standards for reporting BAC so grading is more consistent. That would help ensure more women receive actionable information they can use with their care teams to guide preventive care.

The FDA should also require BAC reporting, just as it now requires breast density reporting. But states do not need to wait for federal action. Maryland recently became the first state to mandate BAC reporting on mammograms by adding BAC language to the breast-density notification law already used in many states, rather than drafting a new bill from scratch.

Health systems should also create clinical protocols, as Mount Sinai and Northwell have done, so that when BAC appears on a mammogram, the radiologist can work with the patient’s care team to pursue a fuller cardiovascular risk evaluation. The Institute Advancing Women’s Health and the Washington Research Foundation are co-funding research aimed at speeding the adoption of BAC diagnosis and reporting across diverse health systems.

None of this depends on new science. Women often move through fragmented care systems in which symptoms involving the heart, brain, bones, metabolism, mood, sleep and reproductive health are treated separately instead of as part of a broader transition in health. Standardized BAC protocols offer a concrete starting point for closing that gap and better supporting women in midlife. The tools are already here; what remains is the will to use them.

Paula Schneider, former CEO of Susan G. Komen, is now CEO of the Institute Advancing Women’s Health (InAWH), a global nonprofit focused on closing the gap between what is known and what is done in women’s midlife health care. Erica Spatz, M.D., MHS, is an associate professor of cardiovascular medicine and epidemiology (chronic diseases) at Yale School of Medicine and a member of InAWH’s Medical Advisory Board.