Breast arterial calcification as a marker of systemic vascular disease: a meta-analysis of prevalence and coronary and non-coronary associations

Background Breast arterial calcification (BAC) detected on mammography has emerged as a marker of cardiovascular risk. Advances in digital mammography and AI-based detection have increased its visibility, yet contemporary prevalence estimates and its broader associations beyond coronary disease remain incompletely characterised. Purpose We aimed to determine the pooled prevalence of BAC and evaluate its associations with both coronary and non-coronary vascular disease. Methods A systematic search of PubMed, MEDLINE and EMBASE from inception to February 2026 identified studies reporting BAC prevalence and its association with cardiovascular risk factors, coronary artery disease, and non-coronary vascular disease (including cerebrovascular and peripheral arterial disease). Random-effects meta-analysis was performed using odds ratios (OR) with 95% confidence intervals (95%CI). Prevalence estimates were Freeman-Tukey double-arscine transformed and pooled using inverse-variance random-effects modelling. Results A total of 116 studies comprising 7,197,068 women were included. The pooled prevalence of BAC was 26.6% (95%CI 23.8-29.4%). Age-stratified prevalence increased from 7.1% (95%CI 3.7-11.3%) in women aged 40-49 years to 48.4% (95%CI 38.0-59.0%) in those aged ≥70 years. BAC was significantly associated with coronary artery disease (OR 3.07, 95%CI 2.33-4.05; p<0.0001) and with non-coronary vascular disease (OR 4.47, 95%CI 2.78-7.17; p<0.0001). Conclusion BAC is common in contemporary mammographic practice and demonstrates strong associations with both coronary and non-coronary vascular disease. These findings support BAC as a marker of systemic vascular calcification rather than a coronary-specific phenomenon, highlighting its potential role in opportunistic vascular risk identification.