Association Between Breast Arterial Calcifications and Increased Cardiovascular Risk: A Canadian Perspective on Clinical Implications and the Potential Role in Preventive Care

Breast arterial calcifications (BAC) are associated with increased cardiovascular risk and have been correlated with other methods of cardiovascular risk stratification. BAC are present in 12% to 43% of patients who undergo screening mammography, with incidence increasing with advancing age. BAC are also positively correlated with multiparity, menopausal status, metabolic syndrome, hyperlipidemia, hypertension, diabetes, and chronic renal disease. There are multiple methods to identify and quantify BAC including visual binary assessment, subjective severity grading, digital measurement and quantification, and artificial intelligence-based models. BAC reporting on mammography is heterogeneous across Canada, Europe, and the United States of America. North American survey studies suggest that referring physicians and patients prefer to be informed of the presence of BAC on mammography. Given the overlap in populations of perimenopausal and postmenopausal women at risk for cardiovascular disease and those undergoing screening mammography, there is an opportunity to use BAC to identify women at increased cardiovascular risk, particularly as current cardiovascular risk assessment models are known to underserve this population.