Breast Arterial Calcification: A Potential Screening Tool for Heart Disease

Routine preventive care for women includes a mammogram every other year beginning at age 40. During her talk at the 2023 American Society of Preventive Cardiology Annual Congress on Cardiovascular Disease Prevention in Arlington, Texas, Dr. Tammy Polonsky, of the University of Chicago, discussed studies that have found a novel way to utilize an incidental finding seen on mammograms.

A mammogram involves low-dose x-rays that create an image of the soft tissue of the breasts, surrounding structures such as bones, and sometimes calcified arteries. Dr. Carlos Iribarren and colleagues demonstrated that an incidental finding, breast arterial calcification (BAC), may be useful for estimating coronary artery disease, specifically coronary artery score (CAC).¹ Results of their study were published in Circulation: Cardiovascular Imaging. BAC is medial artery calcification that can be seen on mammograms and represents arterial stiffness. This potential screening tool is especially important for women whose cardiovascular disease is frequently under- or misdiagnosed.

Dr. Laurie Margolies and her team also conducted a study investigating this relationship, and their findings were published in the Journal of American College of Cardiology. They found a strong quantitative correlation between BAC measured on mammograms and the current standard CAC on coronary computed tomography scans. The 42% of patients in their study population with a positive BAC were more likely to be older, have chronic kidney disease (CKD), or have hypertension.²

Utilization of BAC remains limited. While studies have demonstrated a relationship between BAC and CAC, several studies have also demonstrated a lack of association between BAC and the degree of coronary stenosis in symptomatic female patients.³ This result may be due to the differences in pathophysiology in BAC and CAC that contribute to cardiovascular disease risk in distinct ways.⁴ Furthermore, the positive association between BAC and CAC seen in earlier studies may be confounded by shared risk factors for both disease processes, including CKD and hypertension.

Dr. Polonsky concluded that these studies demonstrate that it is reasonable to refer patients who have BAC >0 for a comprehensive cardiovascular disease risk assessment. Overall, cardiovascular disease is common in women and currently underdiagnosed. As a result, it remains undertreated despite major innovations in the field.

It is clear that more studies characterizing the association between these 2 imaging findings are needed, given that discovering utility in an incidental finding in an already widely used screening test may improve cardiovascular disease diagnosis in a neglected demographic.

Dr. Shivani Hanchate is a resident at the University of Virginia and served as a CardioNerds Conference Scholar for the 2023 American Society of Preventive Cardiology Annual Congress on Cardiovascular Disease Prevention.

References

1. Iribarren C, Chandra M, Lee C, et al. Breast arterial calcification: a novel cardiovascular risk enhancer among postmenopausal women. Circ Cardiovasc Imaging. 2022. doi:10.1161/CIRCIMAGING.121.013526
2. Margolies L, Salvatore M, Hecht HS, et al. Digital mammography and screening for coronary artery disease. JACC Cardiovasc Imaging. 2016;9(4):350-360. doi:10.1016/j.jcmg.2015.10.022
3. McLenachan S, Camilleri F, Smith M, Newby DE, Williams MC. Breast arterial calcification on mammography and risk of coronary artery disease: a SCOT-HEART sub-study. Clin Radiol. 2019;74(6):421-428. doi:10.1016/j.crad.2019.01.014
4. Suh JW, Yun BL. Breast arterial calcification: a potential surrogate marker for cardiovascular disease. J Cardiovasc Imaging. 2018;26(3):125-134. doi:10.4250/jcvi.2018.26.e20