Routine breast cancer screening mammograms could soon be used to detect hidden cardiovascular disease risk in women, potentially preventing thousands of heart attacks.
According to emergency medicine consultant Prof Rob Galloway, using artificial intelligence to analyze routine mammograms could help doctors identify cardiovascular disease far earlier in female patients.
Cardiovascular disease claims more than 80,000 women's lives every year in the UK, killing roughly seven times more women than breast cancer.
A landmark study published in The Lancet in 2021 concluded that women with heart conditions remain understudied, under-recognised, underdiagnosed, and undertreated across the healthcare system.
Heart attack misdiagnosis and female symptoms
Prof Galloway reported recently treating a woman in her late-60s who arrived in A&E suffering a severe heart attack that required urgent surgery to open up a blocked coronary artery.
The patient had experienced identical pain two days earlier, but an A&E doctor had dismissed it as a muscle strain caused by gardening because it did not fit the textbook male presentation of crushing chest pain spreading down the left arm.
The initial pain was almost certainly unstable angina, a critical warning sign that an artery supplying her heart was becoming dangerously narrowed.
Had the condition been recognized during the earlier visit, the patient could have been admitted to hospital and fitted with a stent, a small mesh tube used to open narrowed arteries, before a heart attack occurred and caused potential long-term heart damage.
Prof Galloway stated that medical research and clinical education have long suffered from bias by focusing predominantly on male symptom patterns.
While men typically experience crushing chest pain radiating to the arm or jaw, women often present with different symptoms due to hormonal factors and disease affecting smaller blood vessels in the heart.
Female heart attack symptoms frequently include breathlessness, nausea, fatigue, or localized pain in the back, neck, and jaw.
A 2016 study by the University of Leeds, which analyzed data from more than 500,000 heart attack patients, revealed that women were around 50 per cent more likely than men to receive an initial misdiagnosis upon arriving in hospital.
Patients who received an incorrect initial diagnosis faced a 70 per cent higher risk of dying within 30 days compared with those whose heart attack was detected from the start.
Breast arterial calcification and heart disease risk
Standard cardiovascular risk factors such as smoking, high blood pressure, diabetes, and high cholesterol are widely recognized, but key female-specific risks are often overlooked in routine medical assessments.
These female-specific risk factors include pre-eclampsia, a condition causing high blood pressure during pregnancy, gestational diabetes, premature menopause, and polyendocrine metabolic ovarian syndrome, previously known as polycystic ovary syndrome.
Prof Galloway noted that routine mammograms, offered every three years to women aged 50 to 71 in the UK by the National Health Service (NHS), could provide a vital tool to identify cardiovascular risk long before patients arrive in emergency departments.
When blood vessel walls suffer damage, calcium deposits can accumulate inside them over time.
Radiologists have long observed that calcium can build up in breast arteries during routine cancer scans. Although this breast arterial calcification occurs in a different part of the artery wall than the fatty coronary plaques that cause heart attacks, women with higher levels of breast calcium face a significantly elevated risk of heart attack or stroke.
AI study reveals link between mammograms and heart attacks
Recent research published in the European Heart Journal demonstrated that artificial intelligence software can automatically measure breast arterial calcium from routine screening scans.
Researchers used trained AI software to evaluate mammograms from more than 123,500 women in the United States who were undergoing standard breast cancer screening.
The AI system categorized the women into four groups based on arterial calcification: none, mild, moderate, or severe.
After tracking the participants' medical records over a seven-year period, the study found a direct correlation between breast calcium levels and future cardiovascular events.
Compared to women with no breast arterial calcification, those with mild calcification had around a 30 per cent higher risk of suffering a major cardiovascular event such as a heart attack or stroke.
Women with moderate calcification showed a 75 to 80 per cent higher risk, while those with severe calcification faced roughly three times the risk.
Crucially, the study confirmed that breast arterial calcification carried an extra predictive risk even after accounting for established risk factors like obesity and smoking.
Prof Galloway suggested that calcification data detected by AI during routine screening could be sent directly to a woman's GP alongside her breast-screening result, enabling GPs to check cardiovascular risk and prescribe aggressive blood pressure or cholesterol lowering treatments where necessary.
Alternative tests for cardiovascular risk assessment
Until automated mammogram analysis is routinely incorporated into NHS screening, individuals seeking to assess their cardiovascular risk can utilize alternative diagnostic tests.
A coronary artery calcium scan, which uses a quick CT scan to examine the arteries supplying blood to the heart, offers a direct measurement of arterial condition.
Specialized blood tests can also identify hidden risks, including tests for lipoprotein(a), an inherited cholesterol-carrying particle that increases disease risk even when standard cholesterol readings appear normal.
Testing for apolipoprotein B, or ApoB, measures the total number of potentially artery-damaging cholesterol particles circulating in the blood.
While these specialized tests are not routinely offered on the NHS to healthy individuals due to healthcare costs, Prof Galloway recommended detailed private cardiovascular assessments for individuals with a family history of heart disease or past diagnoses of pre-eclampsia or gestational diabetes.
Additional existing medical tests can also provide heart health data, including retinal photography used in diabetic eye screening, which reveals changes in small blood vessels at the back of the eye, and standard chest CT scans that show coronary artery calcium.
Prof Galloway emphasized that the future of medicine relies on extracting greater clinical information from diagnostic tests that patients already undergo.
He advised women receiving mammogram results to ask whether radiologists noted any breast arterial calcification, and to consult their GP regarding blood pressure and cholesterol management if calcium was detected.
Martha's Rule rollout in emergency departments
In addition to diagnostic improvements, healthcare services in England are expanding patient safety initiatives across emergency care.
Martha's Rule is being rolled out to every A&E department in England, extending patient escalation rights to hospital waiting areas.
The safety process allows patients or their families to request a rapid clinical review from an independent medical team if they observe physical deterioration and feel their concerns are not being addressed by attending staff.
Prof Galloway described the expansion as a brilliant and potentially life-saving initiative, particularly amid severe hospital overcrowding where some patients spend days waiting for hospital beds in emergency corridors where monitoring is difficult.
However, he warned that clear operational guidelines are required to prevent the system from being misapplied.
Martha's Rule must focus strictly on acute physical deterioration rather than general disagreements over diagnoses, hospital discharge decisions, or waiting times.
Prof Galloway cautioned that if clinicians are repeatedly diverted to resolve non-urgent disagreements, it could compromise their ability to prevent genuine acute deterioration in emergency departments.
