Classification and Reporting of Breast Arterial Calcifications: Current State and Ongoing Challenges

Cardiovascular disease (CVD) remains the leading cause of death among women globally, with significant mortality and poorer outcomes compared with men. Traditional CVD risk assessment methods are less effective for women in part due to a lack of consideration for female-specific risk factors and the underrepresentation of women in research. Mammography, primarily used for breast cancer screening, also provides valuable data on breast arterial calcifications (BAC), which are associated with increased CVD risk. Despite its potential, BAC is not routinely reported or used in clinical practice due to variability in reporting practices and the absence of standardized reporting and clinical follow-up guidelines. Various qualitative and quantitative techniques for the classification of BAC and the role of artificial intelligence (AI) in automating BAC quantification have been suggested. Surveys reveal varying attitudes toward BAC reporting among patients, radiologists, and referring clinicians. Despite the potential benefits of BAC reporting for personalized cardiovascular risk assessment, challenges remain, including the need to assess the cost-effectiveness of long-term outcomes, standardized guidelines, and effective follow-up.