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While breast arterial calcification is a common incidental finding on mammograms that is not routinely recommended for follow-up, statistically significant associations with cardiovascular risks may change that approach for postmenopausal women.
For postmenopausal women, new research supports an emerging link between breast arterial calcification (BAC) and the development of cardiovascular disease (CVD).
In a recent study involving over 5,000 women between the ages of 60 to 79, researchers found that 26 percent of the study participants had BAC, according to the recently published study in Circulation: Cardiovascular Imaging.1 Noting 155 cases of hard atherosclerotic CVD and 427 diagnoses of global CVD at a mean follow-up of 6.5 years, the study authors found the presence of BAC had a 1.51 increased hazard of hard atherosclerotic CVD (ASCVD) and a 1.23 increased hazard for global CVD.
More specifically, the study found that women with BAC, a common incidental finding on mammograms, had statistically significant age-adjusted rates per 1,000 person-years for a number of cardiovascular complications including ischemic stroke, CVD death, cerebrovascular disease, cardiomyopathy, deep venous thrombosis/pulmonary embolism and peripheral arterial disease. However, findings from a recent American College of Radiology survey on BAC reporting found that BAC “is not routinely reported or recommended for follow-up in mammogram reports.”2
“We now know that arterial breast calcifications can provide additional information about a woman’s cardiovascular risk,” noted Sabee Y. Molloi, MD, the senior author of the study, in a recent Kasier Permanente release about the study.3 “But to make this knowledge useful and easy to include on a woman’s mammography report, we will need to find a way to automate and standardize how we evaluate the amount of breast arterial calcification present.”
Acknowledging there is no current standard for ascertaining the gradation of BAC, the study authors employed a densitometry method that produces a BAC continuous calcium score akin to scoring for coronary calcium. While this method is not clinically available at the present time, advances in machine learning may aid in further development and clinical translation of this BAC assessment approach, wrote Dr. Molloi, a professor of radiological sciences at the University of California Irvine School of Medicine, and colleagues.4
Noting a survey in which 96 percent of women emphasized that providers should inform them about BAC findings from mammograms, Dr. Molloi and colleagues said patient demand and the findings from their study indicate that BAC reporting should be more commonplace.1,5
“These data, together with our findings, supports the widespread adoption of BAC reporting on mammography and incorporation of BAC in primary prevention guidelines as a novel risk-enhancing factor,” noted Dr. Molloi and colleagues.
Emphasizing that the study was designed to assess the composite outcomes ASCVD and global CVD, the study authors said there was not sufficient statistical power to assess CVD outcomes such as stroke, myocardial infarction, and heart failure. They also noted that a lack of computed tomography (CT) assessment of coronary artery calcium precluded a comparison to BAC. Dr. Molloi and colleagues added that their findings may not be applicable to women below the age of 60 and uninsured populations.
1. Iribarren C, Chandra M, Lee C, et al. Breast arterial calcification: a novel cardiovascular risk enhancer among postmenopausal women. Circulation: Cardiovascular Imaging. 2022;15(3). Available at: https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.121.013526 .
2. Brown AL, Wahab RA, Zhang B, Smetherman DH, Mahoney MC. Reporting and perceptions of breast arterial calcification on mammography: a survey of ACR radiologists. Acad Radiol. 2022 Jan;29 Suppl 1: S192-S198. doi: 10.1016/j.acra.2021.01.027. Epub 2021 Feb 17.
3. Rochman S. Mammography can offer clues to a woman’s heart. Kaiser Permanente Division of Research. Available at: https://divisionofresearch.kaiserpermanente.org/pressrelease?Id=4648 . Published March 15, 2022. Accessed March 18, 2022.
4. Wang J, Ding H, Bidgoli FA, et al. Detecting cardiovascular disease from mammograms with deep learning. IEEE Trans Med Imaging. 2017;36(5):1172-1181.
5. Margolies LR, Yip R, Hwang E, et al. Breast arterial calcification in the mammogram report: the patient perspective. AJR Am J Roentgenol. 2019;212(1):209-214.