A routine mammogram can reveal more than breast cancer. For millions of women, the scan also captures calcium deposits in breast arteries—a warning sign for future heart attacks or strokes. Yet radiologists are not required to report this finding, leaving many women unaware of a risk that kills more Americans than any cancer.
Breast arterial calcification (BAC) is visible on the tens of millions of mammograms performed annually in the U.S., at no extra cost. Heart disease remains the leading cause of death for women, yet the radiologist who spots BAC, the primary care doctor who could act on it, and the cardiologist who could treat it rarely communicate. No country currently mandates BAC reporting, and no standard clinical pathways exist for follow-up.
This gap represents a missed opportunity for personalized risk assessment and early prevention. "A woman's care in midlife depends on where she lives, who she sees, or how her provider was trained," write Paula Schneider, CEO of the Institute Advancing Women's Health (InAWH), and Dr. Erica Spatz of Yale School of Medicine. They argue for a consistent, evidence-based standard.
Early Adopters Show It Works
Some health systems are already ahead. Northwell Health has reported BAC across its 21 hospitals since 2024. Mount Sinai's radiology and cardiology departments collaborate to assess BAC prevalence and define best practices. A Stanford study found that when clinicians and patients were notified of coronary artery calcification—a related finding—they were more likely to act, including a meaningful increase in statin prescriptions.
The McKinsey Health Institute estimates that downstream preventive care based on BAC could cost about $500 per woman and prevent 17,000 to 60,000 cardiovascular events in the U.S. over seven years, saving billions in healthcare costs.
Lessons from Breast Density Advocacy
Advocates point to the successful campaign to mandate breast density notification. Just three years ago, the FDA updated federal mammography regulations to require providers to inform women about breast density, a factor that can obscure cancer on a scan. That change came after sustained coordination among patient advocates like the late Dr. Nancy Cappello and JoAnn Pushkin, organizations like Susan G. Komen, bipartisan lawmakers including Rep. Rosa DeLauro (D-Conn.) and the late Sen. Dianne Feinstein (D-Calif.), and the FDA.
"We don't have to move political mountains to make BAC reporting on mammograms the norm," Schneider and Spatz write. They urge radiologists to standardize BAC grading and call on the FDA to require reporting, as it did for breast density.
Maryland Leads, Others Can Follow
States need not wait for federal action. Maryland became the first state to mandate BAC reporting on mammograms, adding language to its existing breast density notification law rather than drafting new legislation. Other states could follow suit, and health systems can build clinical protocols like those at Mount Sinai and Northwell.
InAWH and the Washington Research Foundation are co-funding research to accelerate BAC implementation in diverse health systems. "None of this requires new science," the authors emphasize. "We have all of the tools in place to make change happen—now we need the will to act."
The push comes as broader debates over how health determinants are framed and healthcare financing challenges continue. For women's health advocates, standardizing BAC reporting is a concrete step toward integrating midlife care and closing the gap between what is known and what is done.
