To evaluate the prognostic value of automated quantification of breast arterial calcification (BAC) on screening mammography for predicting major adverse cardiovascular events (MACE) and mortality.
Approach:
Key Findings:
BAC detected in 16.1% of Emory cohort and 20.6% of Mayo cohort.
Event rates for MACE increased with BAC severity: 5.96 per 1,000 person-years (no BAC) to 48.89 (severe BAC).
Each 1 mm² increase in BAC area correlated with a 1% to 2% increase in cardiovascular risk.
BAC remained an independent predictor of MACE after adjusting for the PREVENT score.
Adding BAC to the PREVENT model improved discrimination in both cohorts.
Interpretation:
Automated BAC quantification from routine mammography may serve as an effective cardiovascular risk assessment tool for women, enhancing existing risk models without additional radiation exposure.
Limitations:
Study was retrospective and dependent on electronic health record data.
Missing variables such as menopause status and reproductive history.
PREVENT scores could only be calculated for a subset of patients due to incomplete clinical data.
Conclusion:
Automated BAC quantification could provide significant prognostic value in assessing cardiovascular risk in women undergoing routine mammography.
More than 80% of women who were partially up to date reported a wellness visit in the prior year, suggesting missed opportunities for screening engagement in primary care.
