The Association Between Breast Arterial Calcification and Subsequent Coronary Artery Calcification: A Systematic Review

Cardiovascular disease (CVD) remains the leading cause of mortality globally. While coronary artery calcium (CAC) scoring is the current gold standard for detecting subclinical atherosclerosis, recent research has highlighted breast arterial calcification (BAC), often incidentally identified on screening mammograms, as a potential non-invasive marker of CVD risk. BAC has been significantly associated with an increased risk of adverse cardiovascular outcomes, including ischemic and hemorrhagic stroke, peripheral vascular disease, and heart failure. This systematic review comprises 14 studies aimed at better understanding the association between the presence of BAC and CAC. The studies consisted of 5,249 women who underwent both BAC and CAC scoring, primarily post-menopausal, with an average age of 57.8 years. The time interval between BAC and CAC assessment ranged from same-day imaging to 2.94 years (mean: 16.2 months; median: 12 months). Across all studies, a consistent positive correlation was observed between the presence of BAC and CAC. Notably, women with both BAC and CAC tended to be older and exhibited a higher burden of coronary artery stenosis, an increased number of affected vessels, and more extensive calcification distribution. The pooled sensitivity, specificity, positive predictive value, and negative predictive value of BAC for detecting CAC were 38.9%, 88%, 73%, and 57.2%, respectively. These findings suggest that the presence of BAC may serve as a useful tool for supporting the presence of CAC in at-risk patients. Given its accessibility, cost-effectiveness, and high specificity, BAC holds promise as a screening adjunct for early CVD detection in women. Standardized guidelines are needed to support radiologists in the consistent reporting of BAC on mammograms and to inform primary care providers on appropriate follow-up and cardiovascular screening for patients with positive BAC findings.