This might just be the breast-kept secret in women’s health.
For people at average risk, most leading medical organizations recommend starting regular mammograms at age 40 to check for signs of breast cancer before symptoms appear.
But that scan may reveal more than just how the girls are doing.
A growing body of research suggests these routine images can also offer subtle clues about heart disease — the leading cause of death among US women.
And yet, there’s a good chance you’ve never heard about it.
That’s probably because, in most parts of the country, doctors aren’t required to tell patients when their mammogram shows signs of breast arterial calcification.
Also known as BAC, the condition occurs when calcium builds up in the middle layer of the breast’s arterial walls. Traditionally, it’s been viewed as little more than an incidental finding on mammograms.
Several recent studies, though, have linked BAC to a higher risk of experiencing cardiovascular events down the road.
In 2022, researchers in California found that women with BAC visible on their mammograms were 51% more likely to develop heart disease or have a stroke than those without it. They were also 23% more likely to develop cardiovascular disease of any kind, including heart disease, stroke, heart failure and disease affecting the peripheral arteries.
In April, a study of 21,514 women found that the more BAC a woman had compared with others her age, the higher her subsequent risk of developing cardiovascular disease in the next 4.7 years.
Importantly, having BAC does not mean a woman has heart disease or needs treatment. Instead, researchers say it may serve as another clue that someone could be more likely to develop problems later in life.
“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,” Matthew Nudy, an assistant professor at Penn State College of Medicine who was involved in the 2026 study, said in a press release. “That may be in part because the current cardiovascular risk assessment tools underestimate risk in women. We need better tools.”
“In the future, assessment of breast arterial calcification may help improve our ability to predict risk and prevent cardiovascular disease.”
Changes on the way?
One state has already taken notice. On Oct. 1, Maryland became the first — and so far only — state to require radiologists to notify patients when BAC is spotted on a mammogram, at no additional cost.
“I’m so glad Maryland jumped in and made the first move [for BAC reporting], and I suspect [other states] are going to follow suit,” Tahira Ahmed, a breast radiologist and medical director of breast imaging for the Maryland imaging network of RadNet, told the Washington Post.
But the new mandate isn’t without controversy.
While the Maryland Radiological Society supported the law, a group of Johns Hopkins breast radiologists opposed it, arguing that the legislation is premature — even while acknowledging the growing research linking BAC to cardiovascular disease.
Their concern? There’s still no established clinical pathway telling doctors exactly what to do when BAC is found. They also warned that the mandate could distract from mammography’s primary job — detecting breast cancer — and potentially lead to unnecessary testing or anxiety.
Still, some doctors argue that patients deserve to know.
“Women can handle scary news,” Dr. Nina Vincoff, Northwell Health’s breast imaging division chief told Applied Radiology last October, though she was not commenting specifically on the Maryland law.
“They’d rather hear it and act on it than be shielded and miss the chance to prevent a heart attack.”
In the US, cardiovascular disease is responsible for about 1 in 3 deaths among women each year.
That’s more than all forms of cancer combined — yet fewer than half of women recognize heart disease as their greatest health threat, according to the American Heart Association.
And it’s not just a disease of older women. Nearly 45% of women ages 20 and older are living with some form of cardiovascular disease, while fewer than half of women entering pregnancy in the US have good cardiovascular health.
