Who knew that mammograms -- with the help of AI -- could help women detect the possibility of heart disease?

Heart disease remains the leading cause of death among women, yet it often goes underrecognized and under-screened. A fascinating story in today's Washington Post reports on a new study published in the European Heart Journal  which suggests that a routine test many women already receive – mammography (Yes, mammography!) – could help identify those at higher cardiac risk.

For decades, radiologists have noticed something unexpected on mammograms: calcium deposits in the arteries that run through breast tissue. Known as breast arterial calcification (BAC), these deposits indicate stiffening blood vessels, which can be associated with cardiovascular disease. Historically, this finding has been considered largely “incidental” and rarely reported. Researchers have now applied artificial intelligence (AI) to change that.

In a large study analyzing more than 120,000 mammograms from women screened at major health systems, an AI algorithm quantified the amount of arterial calcification visible in the scans. The results were striking. Women with more severe calcification had a significantly higher risk of major cardiovascular event (e.g., heart attack, stroke, heart failure, and death) over approximately seven years of follow-up. Those with the most severe arterial calcification on their mammograms had roughly double the risk compared with women who had none.

The public health implications could be substantial. More than 40 million mammograms are performed each year in the United States. Because nearly 70 percent of women over age 40 keep up with breast cancer screening, mammograms could provide a unique opportunity to flag cardiovascular risk in a population of women that might otherwise go unscreened.

This is especially important because many women still mistakenly believe breast cancer is their greatest health threat. In reality, heart disease claims far more lives each year.

Some imaging centers are already beginning to offer AI-based BAC analysis as an optional add-on service to patients receiving mammograms. The AI technology automatically scans images for arterial calcium and generates a score indicating the level of calcification.

Working as a lawyer in the radiology space, I have regularly been amazed by the innovation in the application of technology that arise from those who practice in this field. Here is yet another great example of such innovation! 

If the research on this new diagnostic AI-driven tool proves fruitful – and the newly emerging clinical application of it -- imagine the public health benefit that will come if arterial calcification is routinely reported on all mammograms.