A marker for future heart attacks is visible on one in four mammograms. Almost no radiologist writes it down.
The World Economic Forum and McKinsey Health Institute’s new report, CARE for Women (May 2026), makes a claim that should bother anyone who runs a radiology department: breast arterial calcification is reported in under 5% of patients when radiologists comment on mammography. The signal is already in the image. Nobody is passing it on.
What they found
Breast arterial calcification, or BAC, is calcium in the arterial walls of the breast, and it turns up on standard mammograms without any extra scan, cost, or radiation. It appears in roughly 20–30% of mammograms, and the report links it to about a 58% increased risk of cardiovascular events over time, even after accounting for traditional risk factors like calcium score or lipid profile.
The authors place this inside a larger argument. They attribute 34% of the women’s health gap to care delivery inequities rather than to gaps in what medicine knows — underscreening, underdiagnosis, undertreatment. In other words, a third of the problem is not a research problem. It is a workflow problem.
Their economic case is built on US claims data. Preventive care triggered by a BAC finding costs around $500 per woman, against $100,000–$120,000 to treat a cardiovascular event, yielding a 3–5x return. Scaled across the US, they model 17,000–60,000 cardiovascular events averted over seven years.
There’s an honest obstacle in the report too: radiologists don’t agree on how to score BAC, and some have resisted putting it in breast imaging reports at all. The finding isn’t in BI-RADS. Nobody is paid to look for it.
What this means here
The Indian read on this report is not “we should report BAC.” It’s that the economic argument inverts when you cross the border, and the report never says so.
The US model works because a single insurer or health system pays both the $500 and the $120,000. Prevention is arbitrage for whoever holds both sides of the ledger. In India, most of that spending is out of pocket. The household pays for the follow-up consult, the lipid panel and the statins, and the household also eats the cost of the heart attack. The ROI is real, but it now depends on a family agreeing to spend money today on a risk they can’t feel — and on a woman who is already the last person in most Indian households to get discretionary health spending. A 3–5x return to a health system is not the same as a 3–5x return to a patient.
The second problem is upstream. The whole BAC pathway assumes a mammogram happened. The report notes screening coverage runs 70–80% in high-income regions and below 20% in low-resource settings. India’s public system runs opportunistic clinical breast examination under the NP-NCD programme, not population mammography. So for the large majority of Indian women, the free signal this report is built around never gets generated. The private diagnostic chains — Apollo, Fortis, the standalone imaging centres — are where Indian mammograms actually happen, and they are also the only players who could add a BAC line to a report next quarter without waiting for a guideline. Worth noting that Apollo has a contributor on this report.
The one place the report points at India, it points at Kerala: the Amma Manasu programme, which folded perinatal depression screening into routine antenatal care through public health nurses under the National Health Mission. That’s the actual Indian template here — not a new screening programme, but a line item added to a visit that was already happening.
There’s a third thing the report leaves alone. Gestational diabetes affects roughly one in seven pregnancies globally, but the report cites prevalence approaching 25% in Asian countries. That is the single most India-relevant number in 41 pages, and it gets one clause. A quarter of pregnancies as an entry point for lifelong cardiometabolic risk is not a footnote to the Western story. It’s a different story.
What to watch
Whether any Indian diagnostic chain adds BAC to its standard mammography report template in the next 12 months. It costs nothing, needs no new equipment, and would be the cheapest women’s-health intervention available to a private provider. If none of them do it, the barrier was never cost.
Source: World Economic Forum and McKinsey Health Institute, “CARE for Women: Investing in Care Delivery to Improve Women’s Lives and Livelihoods,” May 2026.r for future heart attacks is visible on one in four mammograms. Almost no radiologist writes it down.