Identification of cardiovascular disease in women using mammograms

Associate Professor Nitesh Nerlekar, Monash University

Future Leader Fellowship

Years funded: 2026 - 2029

Cardiovascular disease (CVD) remains the primary cause of death in women, as well as causing significant health care expenditure. There is a desperate need for a personalized and accessible marker of CVD in women. Breast cancer screening using mammography is an established government-funded program. Certain mammographic features such as breast arterial calcification (BAC) are strongly associated with CVD risk but rarely reported. I and my team have developed a unique artificial intelligence software that can automatically identify and quantify BAC without interruption to clinical workflow. What remains uncertain is if treating individuals with BAC will result in improvements in their CVD risk. In this study, in partnership with BreastScreen Victoria, we will initiate a program using screening mammogram facilities as an entry point for CVD screening in women. We aim to understand approaches to CVD health in women, and preparedness to engage in CVD screening through mammography. We will comprehensively evaluate women with BAC to understand the prevalence of undiagnosed risk factors – it is estimated that 50% of individuals >40yo are unaware of having at least one major CVD risk factor (e.g. diabetes or hypertension). Thereafter, through a randomized controlled trial, we will investigate the visual impact of BAC presence on adherence to lifestyle and medical therapy, and the impact on CVD risk estimation, coronary artery plaque, and future heart attack or stroke. This builds on our recent evidence that visual presentation of coronary calcium levels significantly influences improvement in CVD risk. The impact of this study will be to leverage an established screening service to simultaneously identify three major causes of death in women (heart attack, stroke and breast cancer). Our goal will be to introduce this strategy across all mammogram screening centres, and hence part of our analysis will include cost-effectiveness modelling. This proposal will also reveal mechanistic reasons for the association of BAC with CVD. This lays groundwork for refined future studies with potential for targeted therapies. All this can be achieved without interrupting the core business of BreastScreen which is cancer detection. We aim to disseminate this information through scientific publications, as well as the BreastScreen consumer network. Finally, we expect that this program may also have the effect of increasing BreastScreen attendance rates resulting in the ability to opportunistically influence the health of a majority of Australian women.