Summary
Standard Canadian mammograms capture Breast Arterial Calcification (BAC), a powerful indicator of a woman's heart disease risk. However, radiologists rarely report it. Following landmark US legislation mandating patient notification, this article explores the science behind BAC and empowers Canadian women to proactively access and advocate for their complete medical data
For the last twenty odd years, I have faithfully rolled up my sleeves, walked into imaging clinics, and endured the uncomfortable, cold squeeze of a mammogram machine. Every single time, I walked away with the same singular focus: Please don’t let them find breast cancer. Like millions of Canadian women, I viewed the mammogram as a shield against one specific threat.
But just this week I learned a startling fact that left me shook to the core.
For two decades, those routine X-rays weren’t just looking at my breast tissue. They were also capturing important data that could inform the single biggest killer of women in Canada: heart disease. In fact, up to five times as many Canadian women die of heart disease than of breast cancer. Yet, despite the data being gathered on my film year after year, it was not written down, not sent to my family doctor, and never shared with me.
There is a hidden heart signal in our mammograms called Breast Arterial Calcification (BAC). It is right there on the images. And it is time Canadian women demand to see it.
The “Two-for-One” Diagnostic Tool We Aren’t Using
Breast Arterial Calcification is exactly what it sounds like: a buildup of calcium deposits inside the mammary arteries. It has nothing to do with breast cancer, which is why breast radiologists traditionally ignore it in their write-ups. But to a cardiologist, BAC is a flashing yellow light.
Major medical studies, including research published by the American Heart Association (AHA) and Nature, have established BAC as an independent predictor of cardiovascular disease. When calcium builds up in the arteries of your breasts, it is a strong biological mirror for calcium building up in the arteries surrounding your heart. In fact, research indicates that the presence of BAC can signal a three-to-eight-fold increase in a woman’s cardiovascular risk.
Uncovering this risk requires no additional radiation as the data is already captured on the digital X-ray during a standard mammogram. It’s a flawless “two-for-one” health screening that we are actively throwing in the bin.
BAC vs. CAC: You may have heard of a Coronary Artery Calcium (CAC) score. It’s a specialized chest CT scan used to measure plaque buildup directly in the heart. While highly effective, it costs money, requires extra radiation, and must be specifically ordered. Leading research shows that simply reporting BAC on a mammogram could offer women a similar level of life-saving risk stratification.
The Canadian Gap: Why is This Information Being Suppressed?
If heart disease is the leading cause of premature death for Canadian women, why are radiologists staying silent? The reasons come down to systemic medical silos and bureaucratic hesitation.
First, medicine is heavily compartmentalized. Breast imaging radiologists are trained to hunt exclusively for malignancy. If it isn’t cancer, it often isn’t deemed their responsibility. They assume vascular health belongs to your family doctor, but your family doctor doesn’t see your X-ray films, only the text report. If the radiologist doesn’t type it out, neither you nor your doctor will be aware.
Second, there is pushback regarding clinical guidelines. Some segments of the medical community argue against mandatory reporting because standardized, rigid follow-up protocols haven’t been fully mapped out yet. They worry that reporting BAC will lead to a flood of worried patients, overwhelming primary care doctors who might not know whether to order more tests or prescribe medication.
But as health advocates rightly argue: How can we deny women lifesaving, actionable data that is already sitting in their medical files just because the bureaucracy is slow to write a manual?
History is being Made, but Canadian women are left waiting
Change is entirely possible, and we only have to look across the border to see it happening.
In a historic milestone for women’s health, Maryland recently became the first U.S. state to pass legislation mandating that mammogram patients must be notified if their scans show breast arterial calcifications. Backed heavily by the Brem Foundation, the law recognizes that this data belongs to the patient.
As Dr. Rachel Brem, a leading professor and advocate, points out, this information is deeply actionable. If a woman finds out she has BAC, she doesn’t just sit and worry. She can see a preventive cardiologist, request a formal heart health assessment, proactively change her lifestyle, or start therapies like statins years before a cardiovascular event ever takes place.
Back home, the momentum is simmering but hasn’t boiled over. The Canadian Society of Breast Imaging (CSBI) has issued clear positioning statements recommending that radiologists routinely report BAC. Yet, because it isn’t legally mandated by provincial health ministries, the vast majority of Canadian mammogram reports remain completely silent on the matter.
The Action Plan: How to Demand Your Data Right Now
We don’t have to wait for provincial healthcare systems to catch up to the science. Because it is your body and your medical record, you have the right to advocate for yourself today. Here is how you can bypass the systemic silence:
- Ask at your appointment: When you lie down for your next mammogram, ask the technologist directly: “Will the radiologist note breast arterial calcification (BAC) on my report? The Canadian Society of Breast Imaging recommends it.”
- Pull your full text report: Do not just rely on the standard “Your mammogram was normal” letter you get in the mail. In Canada, you have a legal right to your full medical records. Access your provincial health portal (like MyHealth Records or Ontario HealthEast) or request the full text copy directly from the imaging clinic.
- Scan for the keywords: Read the actual text written by the radiologist. Look closely for terms like vascular calcification, medial arterial calcification, or arterial calcification.
- Take it to your family doctor: If your report notes the presence of these calcifications, bring it to your family doctor or nurse practitioner. Use it as a concrete reason to run a comprehensive cardiovascular lipid panel, check your blood pressure, and calculate your overall heart disease risk score.
- Push for systemic change: Write a brief email to your provincial Health Minister. Ask why your province isn’t following the lead of jurisdictions like Maryland to protect women’s hearts by mandating BAC reporting.
For decades, women have successfully marched, campaigned, and raised their voices to bring breast cancer screening to the forefront of medicine. We changed the world by demanding better diagnostics. Now, it is time to use that exact same collective voice to demand that the healthcare system gives us all the data our bodies are already yielding.
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