Coronary artery calcium (CAC) scores extracted from routine staging 18F-FDG PET/CT scans in 276 women with newly diagnosed breast cancer (mean age 55.5 years, median follow-up 7.1 years) revealed that CAC was present in 25% of patients yet clinically reported in only 5.4% of cases. CAC-positive women faced a 2.75-fold higher age-adjusted hazard of subsequent cardiac diagnostic testing (95% CI 1.43–5.28) and a numerically higher atherosclerotic event rate (7.4% vs 1.4%). Critically, in a prevention-eligible subgroup of 39 women, CAC reclassified statin eligibility in 64%—initiating therapy in 62% of CAC-positive patients and supporting de-prescribing in 67% of CAC-negative patients.
The finding exposes a striking clinical blind spot: imaging data already collected at no additional radiation dose or cost is being systematically ignored. Cardiovascular disease rivals cancer as a leading killer in breast cancer survivors, and the 2026 ACC/AHA dyslipidemia guidelines now formally endorse CAC-guided statin decisions before cardiotoxic treatment. This study positions routine CAC extraction as a low-hanging intervention in cardio-oncology. Limitations are significant: single-center retrospective design, modest cohort size rendering the event analysis underpowered, and potential selection bias in who received staging PET/CT. The prevention-eligible subgroup of just 39 patients is too small for definitive conclusions. As a preprint not yet peer-reviewed, these results require independent validation before clinical protocol changes are warranted. Still, the efficiency argument—repurposing existing scans—makes this finding practically compelling and potentially paradigm-shifting for cardio-oncology workflow.
