Association Between Breast Arterial Calcification on Mammography and Carotid Artery Stenosis on CT Angiography: A Retrospective Study in a Selected Cohort of Women Aged 60–65 Years

Background/Objectives: Breast arterial calcification (BAC) is an incidental mammographic finding that may be associated with systemic vascular disease. We investigated the association between mammographic BAC and carotid artery stenosis on cervical computed tomography angiography (CTA) in a clinically selected cohort of postmenopausal women aged 60–65 years. Methods: This retrospective, single-center study screened 3421 women aged 60–65 years who underwent both mammography and cervical CTA between November 2021 and May 2025. CTA examinations requested from the emergency department or cardiology clinics, examinations not performed within the same calendar year, and prespecified clinical exclusions were removed, leaving 180 women who underwent outpatient CTA for nonspecific symptoms. The median interval between examinations was 131 days. BAC was graded on a 0–3 scale, and carotid stenosis was assessed according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, using the greater degree of stenosis on either side as the patient-level value. BAC was analyzed as an ordinal variable, as a categorical variable, and using binary definitions of presence and severity. Multivariable models were adjusted for age, diabetes mellitus, hyperlipidemia, hypertension, and smoking. Results: Clinically significant stenosis (≥50%) was present in 44 women (24.4%). Its prevalence increased from 5.4% in BAC grade 0 to 75.0% in grade 3 (p for trend < 0.001). Each one-grade increase in BAC was associated with clinically significant stenosis (adjusted odds ratio [aOR], 4.23; 95% confidence interval [CI], 2.50–8.03; p < 0.001). The corresponding aORs were 16.70 (95% CI, 4.99–73.27) for any BAC and 18.49 (95% CI, 5.93–70.46) for BAC grade ≥2. Adding BAC to the clinical model increased the area under the receiver operating characteristic curve (AUC) from 0.90 to 0.96 (DeLong p = 0.005); the optimism-corrected AUC was 0.95. Inter-reader agreement for BAC grading was substantial (weighted κ = 0.79). Conclusions: In this selected cohort of women aged 60–65 years who underwent clinically indicated CTA, BAC was associated with carotid artery stenosis independently of conventional cardiovascular risk factors. These findings do not establish BAC as a screening or prediction tool and require prospective, population-based validation.