Introduction: Breast arterial calcifications (BAC) are a common incidental finding on routine mammography and digital breast tomosynthesis (DBT). Owing to the high spatial resolution of modern imaging modalities, including digital mammography and DBT, more accurate detection of calcified changes in the vascular wall has become feasible. BAC are considered a potential marker of systemic atherosclerosis and may reflect the degree of coronary artery calcification. Given that oncologic patients are frequently exposed to cardiotoxic therapies, early identification of vascular pathology is of particular clinical importance.

Aim: The aim of this study was to evaluate the prognostic significance of breast arterial calcifications (BAC), detected on digital mammography and/or digital breast tomosynthesis, in cardiovascular risk stratification in patients with breast cancer, based on their correlation with coronary artery calcification assessed by multislice computed tomography (MSCT) using the Agatston score.

Materials and Methods: This retrospective study included 50 patients with histologically confirmed breast cancer who were examined at the National Oncology Centre between 2024 and 2025. All patients underwent standard breast imaging, including digital mammography and/or digital breast tomosynthesis (DBT). Breast arterial calcifications were assessed based on characteristic radiographic features of vascular wall calcification on mammographic and tomosynthesis images. To evaluate coronary artery status, all patients underwent multislice computed tomography (MSCT) of the chest with calculation of the coronary artery calcium score according to the Agatston method, enabling quantitative assessment of the degree of coronary calcification.

Results: The study included 50 patients with histologically confirmed breast cancer in whom BAC were detected on mammography and/or DBT. The mean age was 58.4 ± 8.7 years. Arterial hypertension was present in 28 (56%) patients, and diabetes mellitus in 14 (28%). Potentially cardiotoxic chemotherapy (anthracyclines and/or trastuzumab) was administered to 30 (60%) patients. Among patients with coronary artery calcification, mild calcification (Agatston score 1–100) was observed in 16 (32%) cases, moderate calcification (101–400) in 10 (20%), and severe calcification (>400) in 6 (12%) patients. Association analysis demonstrated that coronary calcification was more frequently observed in patients with arterial hypertension (20/28), diabetes mellitus (11/14), and those receiving anthracycline-based chemotherapy (15/22). A positive correlation was found between the severity of BAC and the Agatston score (r = 0.42; p < 0.01).

Conclusion: Breast arterial calcifications detected on digital mammography and/or digital breast tomosynthesis, in combination with MSCT-derived Agatston score, demonstrate a significant association with the presence and severity of coronary artery calcification in patients with breast cancer. These findings support the potential role of BAC as an additional imaging biomarker of systemic atherosclerosis in the oncologic population. This feature may be valuable for cardiovascular risk stratification in patients undergoing anticancer therapy, particularly those receiving potentially cardiotoxic treatment. Incorporating the assessment of BAC into routine mammographic interpretation may facilitate earlier identification of patients at increased cardiovascular risk and optimize their subsequent clinical and instrumental follow-up within the framework of cardio-oncology.

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