New Score Predicts Coronary Calcification From Mammography

Pam Harrison

April 24, 2015

TORONTO — A novel breast arterial calcification (BAC) score that uses findings from standard digital mammography is predictive of underlying coronary calcification and cardiovascular disease risk, a new study shows.

"This is almost the 'perfect storm' because the age range for people who are having mammograms is the same as the age range for those who might benefit the most from preventive cardiology," said Laurie Margolies, MD, from the Icahn School of Medicine at Mount Sinai in New York City.

"If breast arterial calcification is a surrogate for coronary artery calcium, or if it could augment documented risk-factor analysis, mammography could play a part in cardiovascular disease prevention and early intervention," she pointed out.

"We found that the BAC score significantly predicts the presence of coronary artery calcium with an overall accuracy of 69%," she reported here at the American Roentgen Ray Society 2015 Annual Meeting

The study involved 325 women who had a noncontrast chest CT and a traditional mammogram within 1 year of each other.

If calcified vessels were identified on the mammogram, the investigators calculated the BAC score by evaluating the number of vessels involved, the length of the vessel involved, and the density of calcium involvement in the lumen.

They determined that breast arterial calcification was present in 45.5% of the cohort.

For each patient, they then compared the BAC score with the Coronary Artery Calcium Score. A calcium score of 4 or higher indicates significant risk for cardiovascular disease.

Agreement between the two scores was "highly significant," Dr Margolies reported.

Matching Calcification Scores

For patients with a calcium score of 0, 76% also had a BAC score of 0, whereas 11% had a BAC score of 1 to 3 and 13% had a BAC score of 4 to 12.

For patients with a calcium score of 4 to 12, 55% also had a BAC score of 4 to 12, whereas 29% had a BAC score of 0 and 16% had a BAC score of 1 to 3.

The mechanisms of breast arterial calcification and coronary artery calcification are different. Breast calcification is medial in location, whereas coronary calcification is located in the intima, Dr Margolies explained.

In addition, mammary arteries are branches of several different arterial systems that are considered to be unsusceptible to conventional atherosclerosis.

"Each of the individual variables we had in the BAC were all significantly predictive of the calcium score (P < .0001)," Dr Margolies pointed out.

Calcification in the breast is in the media, which is a different kind of calcification than occurs in the coronaries.

Predictably, BAC-positive patients were significantly older than BAC-negative patients (66.8 vs 58.2 years; P <.0001). There was also more hypertension in BAC-positive than in BAC-negative women (78% vs 55%; P = .0002).

Paradoxically, fewer BAC-positive than BAC-negative patients were smokers (11% vs 23%; P < .0087).

"Right now, I'm putting this information in the mammography report, but whether the primary care physician who ordered the mammography is picking it up or acting on it, I don't know," Dr Margolies told Medscape Medical News.

"But cardiologists are extremely interested in this research. They are looking to prevent strokes and heart attacks, so anything that encourages women to be more proactive about their cardiovascular health is greatly welcomed," she said.

And as imagers of women, "I think we need to focus on the entire body, and not just the breast," she added.

It is important that these findings be corroborated with further research, said Paula Gordon, MD, from the University of British Columbia in Vancouver, Canada.

"As Dr Margolies pointed out, calcification in the breast is in the media, which is a different kind of calcification than occurs in the coronaries," Dr Gordon told Medscape Medical News. "We need to make sure that this is a real association that matters."

Dr Gordon said that she will occasionally mention the presence of breast calcification in her reports, especially if the calcification visualized on mammography is moderate to severe and the woman in younger.

"Breast calcification is usually easy to see and quite characteristic," she explained.

"I might mention it in our reports and ask whether the patient has other risk factors for coronary artery disease. If she does, the report just might prompt the kind of questions regarding cardiovascular disease risk factors that might not otherwise have come up, and the patient can then go on for further screening," Dr Gordon explained.

This study was funded by the Flight Attendants Medical Research Institute. Dr Margolies and Dr Gordon have disclosed no relevant financial relationships.

American Roentgen Ray Society (ARRS) 2015 Annual Meeting: Abstract 1226. Presented April 22, 2015.


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