Breast Arterial Calcification Potential Marker for CVD
Breast arterial calcifications, which are medial calcifications of the breast arteries that often appear on mammograms, should be considered a risk factor for coronary artery disease in women, menopause experts suggest.
“In our study, among women with no coronary disease at baseline, those with breast arterial calcifications had a higher likelihood of developing coronary disease over time than those without,” said study investigator Peter Schnatz, DO, from Reading Hospital in Pennsylvania.
“This baseline association has been shown in other studies, so our results are confirmatory to those studies. But do the patients who have calcifications have a higher incidence of heart disease over time? Our study would suggest that they do,” he told Medscape Medical News.
The prevalence of breast arterial calcifications on mammography ranges from 3% to 29%. Because their nature is benign, and not a sign of cancer, they are often ignored in the radiology report.
“Once the radiology community, as a whole, decided these were just benign findings, there was inconsistency in their reporting. Some women would have in their report that, by the way, there is some calcification here, and other reports wouldn’t even mention it,” lead researcher Ragad Asmaro, MD, from Drexel University Hahnemann Hospital in Philadelphia, told Medscape Medical News.
Dr Schnatz began studying the association between these calcifications and cardiovascular disease (CVD) several years ago. He presented 10 years of prospective follow-up data at the North American Menopause Society (NAMS) 2016 Annual Meeting in Orlando, Florida.
The study participants underwent routine mammography from June to August 2004. Data were collected on risk factors for CVD at baseline and on CVD events — such as angina, myocardial infarction, abnormal coronary angiogram, coronary artery bypass graft — and stroke experienced during the 10-year follow-up period.
Of the 1029 women available for follow-up at 10 years, 112 were positive for calcifications at baseline and 917 were negative (10.9% vs 89.1%).
The women who developed CVD by year 10 were significantly more likely to have been positive at baseline than negative (9.8% vs 3.3%; P = .001).
And calcification-positive women were 2.3 times more likely than calcification-negative women to develop CVD, after age was controlled for (confidence interval [CI], 1.07 – 5.07; P = .034).
By year 10, calcification-positive women were significantly more likely to have experienced at least one stroke event than calcification-negative women (8.8% vs 2.1%; P <.001).
And positive women were 3.2 times more likely to have experienced a stroke than negative women, after age was controlled for (CI, 1.22 – 8.41; P = .018).
“Some of the current tools, like the Framingham risk model, use a host of risk factors to come up with a composite prediction of risk for coronary disease over a 5- to 10-year period,” said Dr Schnatz. “In my mind, one of the big questions is, should breast arterial calcifications be added into that?”
“If identified on routine mammography, these breast arterial calcifications should no longer be considered benign, but instead a possible marker for increased risk for heart disease and stroke,” said JoAnn Pinkerton, MD, from the University of Virginia Health Center in Charlottesville, who is executive director of NAMS.
“The presence of these calcifications should be reported on mammogram findings and conveyed in the mammogram results. More research is needed to confirm these findings,” she told Medscape Medical News.
If they are confirmed, researchers will have to determine how to incorporate breast arterial calcifications into cardiovascular prediction tools, she said.
North American Menopause Society (NAMS) 2016 Annual Meeting: Abstract P8. Presented October 7, 2016.