Finding Heart Health Warnings on Screening Mammograms
Opportunistic breast screenings may offer an important glimpse into women's cardiovascular health
Despite what some women may think, cardiovascular disease (CVD)—not breast cancer—is their biggest health risk, asserted Samantha Platt, MD, a resident in the Department of Radiology at NYU Langone Health in New York City.
Women need earlier and more widespread detection of CVD, according to Dr. Platt. That’s why she and her colleagues recently conducted a study focused on breast arterial calcifications (BAC) and screening mammograms. She presented the findings at RSNA 2025.
“We wanted to explore if these calcifications, which are easily detectable on mammography and are underreported, have any relation to coronary artery calcifications (CAC), an important marker of cardiovascular disease,” she said.
“We were hoping that routine annual screening mammography can act not only as breast cancer screening, but also as opportunistic screening for cardiovascular disease, without any further work, cost or radiation to the patient,” Dr. Platt added.
The researchers retrospectively applied an AI algorithm trained on millions of mammograms -with outputs confirmed via manual radiologist review to detect BAC in a cohort of 5,100 women (mean age, 66 ± 10 years, 65% white). The women had undergone both screening mammography and electrocardiogram-triggered coronary artery calcium CT within 12 months.
“We performed chart review, looking for major adverse cardiovascular events including myocardial infarction or need for coronary revascularization (i.e., stent or bypass) and assessed how BAC predicts these outcomes,” Dr. Platt said.
They found BAC in 1,421 women (28%) and 876 major adverse cardiovascular events (MACE). They also identified a positive correlation between BAC and CAC.
“Our major findings include that the presence of BAC correlates positively with the presence of CAC,” she said. “Additionally, BAC had a high negative predictive value for identifying myocardial infarction (98%) and coronary revascularization (97%), which means that if a woman does not have breast arterial calcifications, her risk of a major adverse cardiac event is very low.”
The investigators were surprised by how strong the negative predictive value of BAC is for CAC.
“This finding should be incredibly reassuring to our patients that they have a low risk of MACE if they don’t have BAC,” she said.
Listen as Dr. Platt shares research revealing how BAC seen on routine screening mammograms may offer an opportunistic window into women’s cardiovascular risk.
The Power of Opportunistic Screenings—and AI
“We would like to tell radiologists that, although the relationship between BAC and coronary artery calcification requires more investigation, we think this will become an important finding to report routinely in mammographic examinations as it has a relationship to cardiovascular disease,” Dr. Platt said. “We also believe that using an AI algorithm can help to detect these findings, all without increasing the burden on the radiologists.”
BAC is an active and exciting field of investigation, Dr. Platt asserted. She and her colleagues are working on a BAC quantification and scoring algorithm akin to the Agatston score used for the heart to further improve the value of using BAC to predict CVD.
“Women are less likely to be identified as high risk for heart disease and offered opportunities to change that risk,” she noted. “With widespread implementation and appropriate follow-up, we think this finding has the potential to significantly decrease the number of adverse cardiovascular events in women, since it will allow for earlier cardiology referral and treatment.”“With widespread implementation and appropriate follow-up, we think this finding has the potential to significantly decrease the number of adverse cardiovascular events in women, since it will allow for earlier cardiology referral and treatment.”
— SAMANTHA PLATT, MD
Another Large Study Finds Similar Results
Mohammad Eghtedari, MD, PhD, former professor of radiology at the University of California, San Diego, and colleagues also conducted a recent study assessing BAC during screening mammograms to help identify CVD.
In their single-center, retrospective study of more than 18,000 women, the team used an investigational deep neural network AI tool to automatically quantify the severity of BAC on screening mammograms.
They found that BAC is independently associated with mortality and CVD. In addition, the association between BAC and cardiovascular risk was stronger and more prominent in younger women—particularly those under 60 years.
“Routine screening mammograms begin at age 40, primarily to prevent breast cancer deaths,” said Dr. Eghtedari, who now serves as a professor of radiology and section chief of women’s imaging at the City of Hope National Medical Center in Duarte, California. “At this relatively young age, most women are not yet aware of their cardiovascular disease risk—even though CVD remains a leading cause of mortality in the United States.”
He emphasized that contrary to traditional thinking, BAC is associated with cardiovascular disease and should no longer be dismissed as an incidental or clinically insignificant finding. In addition, BAC reporting is gaining traction and is now included as a MIPS quality reporting through the American College of Radiology’s Qualified Clinical Data Registry (2025).
“This approach has the potential to identify women at elevated cardiovascular risk as early as ages 40 to 50, prompting timely referral for dedicated cardiovascular risk assessment by a specialist,” Dr. Eghtedari said. “This could be lifesaving for women at high risk currently unaware of their vulnerability.”
For More Information
Access the Journal of the American College of Cardiology study, “Automated Breast Arterial Calcification Score Is Associated with Cardiovascular Outcomes.”
Read previous RSNA News articles on opportunistic screening: