Your Mammogram May Reveal a Heart Health Clue That Maryland Now Requires Providers to Report
Guest Contributor
Women in Maryland who go for routine mammograms may now see an unexpected new line in their results letter: a note about “breast arterial calcification,” or BAC. This finding does not mean breast cancer, yet lawmakers and clinicians believe it could quietly open a window into a woman’s heart health. With heart disease remaining the leading cause of death for women in the United States, Maryland’s move to flag BAC on mammogram result letters reflects a growing interest in using existing imaging in smarter, more preventive ways.
The new requirement comes from Maryland House Bill 1364, which passed with unanimous support in both chambers of the state legislature and took effect on October 1. Under this law, mammography centers must include a notice in the standard results letter whenever breast arterial calcification is seen on the scan. This is a specific kind of calcium buildup in the blood vessels of the breast. It is distinct from the calcifications radiologists look for when assessing breast cancer. According to the legislation, the notice explains that BAC is a common finding that may be associated with increased cardiovascular risk and encourages women to discuss it with their physician.
Radiologists emphasize that BAC is not a sign of breast cancer and does not itself diagnose heart disease. As Dr. Lisa Mullen, an associate professor of radiology at Johns Hopkins University who helped revise the draft legislation, explained to NPR, arterial calcifications in the breast are separate from cancer screening and are reported simply as a yes or no finding. The intent is to prompt a conversation rather than to deliver a diagnosis or a scare. When present, BAC becomes another piece of information that can help a clinician evaluate a woman’s overall risk for cardiovascular disease.
What makes this new notice potentially important is the research connecting breast arterial calcification with higher rates of serious cardiovascular outcomes. Studies have found that women with BAC are more likely to experience events such as heart attacks, heart failure, stroke or even death, compared with women whose mammograms show no such calcification. In a 2024 study published in JACC: Advances that included 18,092 women screened at UC San Diego Health, about 23 percent had BAC detected. Those women had a 49 percent higher adjusted risk of death and a 57 percent higher adjusted risk of a combined outcome that included heart attack, heart failure, stroke or death.
The association appeared particularly strong among women ages 40 to 59, which is a group often in the thick of careers, caregiving and other demands that can push preventive care to the background. The study used an artificial intelligence tool developed by CureMetrix to detect BAC on mammograms, and the senior author has served as a consultant to the company, a detail that highlights how emerging technology and commercial interests can intersect in this field. Still, an editorial co written by cardiologist Dr. Ana Barac stressed that BAC is a finding rather than a disease. She advised that the result should not be a source of panic but instead a prompt for thoughtful risk assessment.
Earlier work has pointed in the same direction. A small study presented at the American College of Cardiology’s 2016 meeting examined 292 women and found BAC in 42.5 percent of participants. About 70 percent of those with breast arterial calcification also had calcium in their coronary arteries, which supports the idea that calcification in the breast vessels may mirror what is happening in the heart’s arteries. Broader estimates suggest that BAC becomes more common with age, present in roughly 10 percent of women in their 40s and about half of women in their 80s, according to an American Heart Association news report.
Even so, the current evidence shows correlation, not proof that BAC causes heart disease. No trial has yet demonstrated that notifying women about this finding directly leads to fewer heart attacks or deaths. That uncertainty has fueled debate within the radiology community about whether a legal mandate to report BAC is timely or premature. A group of Johns Hopkins breast radiologists wrote to lawmakers expressing concern that the legislation was not adequately supported by the evidence base and that no established clinical pathway yet exists for managing patients who receive a BAC notice.
The absence of national guidelines is a key part of this discussion. At present, there is no consensus protocol that specifies what primary care doctors or cardiologists should do next when they see BAC mentioned in a mammogram report. Critics of the Maryland law worry that, without clear recommendations, some women might undergo unnecessary additional testing that increases costs and anxiety without demonstrated benefit. Others argue that ignoring a potentially useful marker of risk would be a missed opportunity, especially when the information comes from an image already being taken for another purpose.
The law itself tries to strike a cautious balance. It clearly states that it does not create a standard of care or a basis for a lawsuit and does not require insurers to cover any follow up heart testing. The Maryland Department of Health is authorized to update the notice in the future if medical evidence evolves. The requirement applies to mammography centers across the state, including hospitals, clinics and private radiology practices, although federal Veterans Affairs facilities are excluded. Women in other states may already see BAC noted in their radiology reports in a more technical way, but reporting practices vary and there is no consistent national approach.
For a woman reading her own mammogram letter, the practical question becomes simple: what should she do if BAC is mentioned? The recommended next step is not emergency action but communication. Bringing the letter to a primary care provider and asking how this finding fits with blood pressure, cholesterol levels, blood sugar, smoking history, family history and other factors can help shape a more complete picture of cardiovascular risk. Based on that overview, a clinician might suggest lifestyle changes, routine monitoring or, in selected cases, further heart testing. Because the law does not require coverage of additional imaging, women are advised to check with their insurance plan before scheduling extra tests.
It is also important to separate routine risk conversations from urgent warning signs. Any person who experiences chest pain or pressure, shortness of breath, pain spreading to the arm, jaw or back, or sudden nausea or lightheadedness should seek emergency care whether or not BAC appeared on a mammogram. Women can have less typical heart attack symptoms than men, so paying attention to new or unusual symptoms remains essential.
I found it striking that a small, often overlooked note on a mammogram report might one day influence how clinicians think about women’s heart health at scale. Maryland’s law represents an early attempt to formalize that potential by ensuring patients are told about breast arterial calcification when it is seen. Whether this approach will translate into better outcomes through more timely prevention or treatment is still an open question. As more research emerges and guidelines develop, the conversation sparked by a simple line in a results letter may help refine how health systems integrate cardiology and breast imaging for the benefit of women’s long term health.