Smart Tech AI Can Now Analyze Your Mammograms to Predict Risk of Heart Disease

A new study shows that AI can be used to evaluate the build-up of calcium deposits in the breast arteries from X-ray mammography scans that are used in routine breast cancer screening.

Sophia Antipolis/France – The risk of serious or fatal heart disease can be predicted with artificial intelligence (AI) analysis of mammograms, according to research published in the European Heart Journal.

The study shows that AI can be used to assess the build-up of calcium deposits in the arteries of the breast from the standard X-ray mammography scans that are currently used in routine breast cancer screening.

Researchers say this technique could help the disproportionate number of women who have undiagnosed and untreated cardiovascular disease.

The study is by a team of researchers led by Dr. Hari Trivedi from Emory University, Atlanta, USA. He said: “Heart disease is the leading cause of death in women worldwide, yet women are consistently underdiagnosed and undertreated compared to men.

“Mammograms, which women already attend for breast cancer screening, can also reveal calcium deposits in breast arteries and this is linked to heart disease. We wanted to test whether AI could use this to identify women at risk of cardiovascular disease at no extra cost or inconvenience.”

The study included 123,762 women who had taken part in breast screening but had no known cardiovascular disease. Researchers used AI to analyze the amount of calcium deposit in the arteries of the breast tissue. This ‘arterial calcification’ is known to be a sign that the arteries are becoming hardened, and indicates a higher risk of conditions such as heart attack, heart failure stroke, and death. The amount of arterial calcification in the women’s breast tissue was categorized as severe, moderate, mild or absent.

Researchers compared this categorization with information on whether the women went on to develop serious cardiovascular disease, including stroke, heart attack or death from cardiovascular disease. They found that women with mild calcification were around 30 % more likely to suffer serious cardiovascular disease compared to women with no calcification. In women with moderate calcification, the risk was more than 70 % higher and in women with severe calcification, the risk was two to three times higher.

Dr Trivedi said: “We found that the more calcium visible in the breast arteries on a mammogram, the higher a woman's risk of a serious heart event such as a heart attack, stroke or heart failure. This was true even in younger women under the age of 50 a group often considered low-risk and held up after accounting for other risk factors like diabetes and smoking. This is the largest study of its kind and covers multiple races and across two major US health systems.”

“For women, this means a mammogram you're already having could also provide important information about your heart health prompting a conversation with your doctor about preventive steps such as cholesterol testing or medication. For clinicians, it offers a practical way to identify women at cardiovascular risk who are currently being missed.

“Policymakers could consider integrating this into existing mammography programs, potentially reaching tens of millions of women annually without any additional infrastructure. The main steps needed are integrating the AI tool into existing imaging workflows and establishing clear guidelines for notifying patients and doctors. We are now planning a clinical trial designed to test these steps.”

In an accompanying editorial Professor Lori B. Daniels from University of California, San Diego, USA, said: “Two-thirds of women aged 50–69 in the European Union reported a mammogram within the prior 2 years, and in the USA, nearly 70 % of women aged 45 years and older were up to date with mammography according to American Cancer Society screening guidelines. In contrast, <40 % of women report knowing their cholesterol levels.

“Breast arterial calcification (BAC) has the potential to reframe this mismatch, leveraging a widely adopted cancer-screening platform to identify cardiovascular risk in women who may not otherwise engage with prevention.

“[…] Dapamede et al. provide compelling evidence that AI-quantified Bac is an independent marker of cardiovascular risk and mortality, with a standardized mm2 metric that supports implementation. Regardless of the reporting metric ultimately adopted, it is time to shift BAC from observation to implementation, leveraging a touchpoint women already trust, to advance prevention for what remains the leading cause of death among women.”

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