- Mammograms may do more than detect breast cancer — the routine X-ray check may also offer insight into heart health.
- Research shows that breast arterial calcification (BAC), which forms in the breasts, may indicate potential risk for cardiovascular disease.
- Reporting BAC on mammograms has become a major push among leading healthcare organizations.
Mammograms are widely used to help detect breast cancer, but they may also offer insight into heart health.
The routine X-ray screening may identify breast arterial calcification (BAC), which is the presence of calcium deposits within the walls of the small arteries in the breast.
On a mammogram, BAC is commonly identified as thin, white, parallel lines that give a “tram-track” appearance.
While BAC is harmless to the breasts, it is associated with a significantly higher risk of cardiovascular disease. A
“The reasons for BAC resulting in higher risks for cardiovascular disease are not definitely determined; however, there are some potential mechanisms, one being that they share similar risk factors that result in vascular injury or metabolic stress that result in vascular calcification and atherosclerosis,” Mehta told Healthline.
Cheng-Han Chen, MD, interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center, added that because BAC and heart disease share many of the same risk factors, “calcium in breast arteries therefore suggests disease in the heart (coronary) and brain arteries as well,” he told Healthline.
While 1 in 39 females in the United States dies from breast cancer each year, cardiovascular disease causes one out of every three deaths, resulting in 1 death per minute.
“Cardiovascular disease is still the most common cause of death in premenopausal women,” Richard Reitherman, MD, PhD, a radiologist and medical director of breast imaging at MemorialCare Breast Center at Orange Coast Medical Center, told Healthline.
“The presentation of cardiovascular disease in premenopausal women is notoriously different than in postmenopausal women, primarily [because] there are no typical symptoms such as chest pain.”
Reitherman said that a prevalent and common health screening procedure such as a mammogram can lead to the early identification of women with silent cardiovascular disease.
“Cardiovascular outcome studies that have included breast arterial calcifications as a risk factor are increasingly reported in the medical literature,” he said.
“The hope is that identifying younger women with silent cardiovascular risks [like BAC along with] appropriate integrated risk identification, analysis, and interventions can significantly reduce mortality in this age group.”
Mehta said there are several reasons BAC has been overlooked as a risk factor for heart disease.
“Mammograms are completed for assessment of breast cancer, and BAC has been historically an ‘incidental’ finding, which is not clinically relevant from an oncologic standpoint,” she said.
Additionally, there is no standardization on quantification of BAC severity, nor is it a required component of mammogram reports, said Mehta.
However, routine reporting of BAC on mammograms is an urgent goal of the American College of Radiology, Society of Breast Imaging, and Medicare, said Reitherman.
In fact, it is gaining traction in the United States. A new Maryland law, passed on October 1, requires mammography centers to notify women when a BAC is detected on their mammogram.
“Automated identification and reporting of these calcifications detected on screening mammograms will become increasingly prevalent in the coming months [and] years,” said Reitherman.
The next step is to identify this group of women to primary care physicians so that appropriate risk evaluation can take place, Reitherman added.
In addition to doctors routinely screening for conditions related to heart disease, such as diabetes, high blood pressure, and high cholesterol, he hopes BAC will also be routinely considered.
“Under current development are protocols to identify patients needing a cardiologist’s training and expertise to appropriately stratify this group of patients,” said Reitherman.
“The common healthcare behavior [of] having regular mammograms not only reduces risk of morbidity and mortality from breast cancer but will hopefully contribute to the reduction of morbidity and mortality from cardiovascular disease in younger women.”
He said this type of integrated healthcare approach demonstrates cross-specialty integration and coordination among women, radiologists, and their healthcare providers to improve women’s lives.
“This is an amazing game-changing opportunity,” Reitherman said.
Mehta said it’s reasonable for women to ask if BAC is present on their mammogram report.
“But if it is not uniformly reported by the radiologist, the individual clinician may not have the answer,” she said.
More research is needed before BAC on mammograms can be used routinely to predict heart disease.
Finding out your BAC could provide additional information to help you and your doctors decide how aggressively to address your cardiovascular risk factors, Chen said.
Reitherman agreed. “The goal of reducing morbidity and mortality from any cause such as cardiovascular disease is based on recognition of risk factors, followed by appropriate lifestyle and pharmacologic interventions,” he said.
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