The amount of calcium in the arteries of the breast, readily visible on digital mammography, is linked to the level of calcium buildup in the coronary arteries, according to a study presented at the American College of Cardiology’s 65th Annual Scientific Session. This link suggests that mammography may also screen women at risk for heart disease,potentially enabling earlier intervention.1
Coronary arterial calcification (CAC) is considered a very early sign of cardiovascular disease, and the presence of breast arterial calcification appears to be an equivalent or stronger risk factor for CAC than other well-established cardiovascular risk factors such as high cholesterol, high blood pressure, and diabetes. The data from this study provide a more direct relationship between the extent of calcified plaque in the mammary and coronary arteries, as well as a comparison to standard risk evaluation.
“Many women, especially young women, don’t know the health of their coronary arteries. Based on our data, if a mammogram shows breast arterial calcifications it can be a red flag—an ‘aha’ moment—that there is a strong possibility she also has plaque in her coronary arteries,” said Harvey Hecht, MD, professor at the Icahn School of Medicine and director of cardiovascular imaging at Mount Sinai St. Luke’s hospital in New York City, and lead author of the study.
The study, which included 292 women, found breast arterial calcification in 124 women (42.5%). Furthermore, 70% of the women with evidence of breast arterial calcification on their mammograms also had CAC on a noncontrast CT of the chest. Half of the women younger than 60 years also had breast arterial calcification, which is an important finding in women so young. The younger patients had even fewer false positives: if a younger woman had breast arterial calcification, the chances of CAC were 83%.
Breast arterial calcification was more powerfully predictive of cardiovascular risk than the Framingham Risk Score, which underestimates women’s risk, and the 2013 Cholesterol Guidelines Pooled Cohort Equations, which tends to overestimate risk, Hecht explained.
“This information is available on every mammogram, with no additional cost or radiation exposure, and our research suggests breast arterial calcification is as good as the standard risk factor-based estimate for predicting risk,” Hecht said. “Using this information would allow at-risk women to be referred for standard CAC scoring and to be able to start focusing on prevention, perhaps even taking a statin when it can make the most difference.”
“The message is if a woman is getting a mammogram, look for breast arterial calcification. It’s a freebie and provides critical information that could be lifesaving for some women,” Hecht said, adding he hopes these findings will prompt clinicians, who rarely report breast arterial calcification, to routinely report not just the presence or absence of breast arterial calcifications but also to estimate and note the amount.
“The more breast arterial calcification a women has, the more likely she is to have calcium in her heart’s arteries as well. If all it requires is to take a closer look at the images, how can we ignore it?” he said.
1. American College of Cardiology. Mammograms: another way to screen for heart disease? [news release]. EurekAlert! Web site. http://www.eurekalert.org/pub_releases/2016-03/acoc-maw031816.php. Accessed April 12, 2006.