Digital mammography can help predict heart disease.

Mammography could help predict heart disease in women by detecting signs of calcium in the arteries of the breast. This could make early treatment possible, with potential benefits, especially for young women.

The findings are being presented at the American College of Cardiology’s 65th Annual Scientific Session in Chicago, IL, and will also be published in JACC: Cardiovascular Imaging.

Heart disease causes 22.4% of deaths among women in the US; cancer, particularly breast cancer, is responsible for 21.5% of fatalities. According to the Centers for Disease Control and Prevention (CDC), these are two leading causes of death among women in the US.

Around 37 million mammograms a year takes place in the US. The American Cancer Society recommend yearly mammography for women aged 40-54 years and those at high risk for breast cancer, and every 2 years for those aged 55 years and older.

Digital mammography, used in 96% of mammography units in the US, can detect calcifications. This information could help to indicate how much calcium is building up in the coronary arteries too.

Coronary arterial calcification (CAC) is a very early sign of cardiovascular disease (CVD), and previous research has associated CAC with breast arterial calcification and atherosclerotic disease, heart attack, stroke and other cardiovascular conditions.

Breast arterial calcification correlates with CAC

Current findings suggest that breast arterial calcification could be an equal or stronger indicator of future heart disease than high cholesterol, high blood pressure and diabetes.

Fast facts about women and heart disease

  • Heart disease killed 292,188 American women in 2009
  • 64% of women who died of heart disease have no prior symptoms
  • Heart disease affects 7.6% of black women, 5.8% of white women and 5.6% of Mexican American women.

Learn more about heart disease

Dr. Harvey Hecht, professor at the Icahn School of Medicine at Mount Sinai in New York City, NY, and director of cardiovascular imaging at Mount Sinai St. Luke’s Hospital, and colleagues compared data for 292 women who underwent mammography and a non-contrast computed tomography (CT) scan of the chest within 1 year. None of the participants had a previous diagnosis of CVD.

Breast arterial calcification and CAC were both evaluated on scales from 0-12, where 12 was the highest.

Results showed that 124 women, or 42.5% of the participants, showed signs of breast arterial calcification, and 70% of these women also had CAC while 63% of those whose CT scan showed CAC also had breast arterial calcification.

Half of the women aged under 60 years had both CAC and breast arterial calcification. In younger women with breast arterial calcification, 83% had CAC.

CAC was more likely in older women with high blood pressure and chronic kidney disease, but results indicate that in those with breast arterial calcification, CAC is three times more likely.

When evaluated against the Framingham Risk Score and the 2013 Cholesterol Guidelines Pooled Cohort Equations, outcomes were similar, but when researchers included 33 asymptomatic women with CAD, the tool appeared to be a more effective indicator than the others.

The findings suggest that subclinical atherosclerosis may predict the risk of heart disease more effectively than other risk factors.

Call for reporting of calcification levels alongside breast cancer results

One benefit of using mammography to predict heart disease is that each screening provides a readily available score without extra cost or intervention. Such reporting would enable patients and physicians to start working on prevention, maybe by taking a statin, say the authors.

Dr. Hecht says:

“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.”

The researchers point out that atherosclerosis in breast arterial calcification is different from those in CAC, and they do not yet know how they are related. The team calls for further research to validate the findings. A study involving 39,000 subjects is currently underway in the Netherlands.

Hecht urges clinicians to start reporting the presence and amount of breast arterial calcification on a regular basis.

In an accompanying editorial due to appear in JACC: Cardiovascular Imaging, Dr. Khurram Nasir and John McEvoy, from the Center for Healthcare Advancement and Outcomes at Baptist Health South Florida, say the research “provides impetus to document breast arterial calcification in mammography reports, to improve education of primary care and radiology providers on the link with heart disease, and other actions to establish best practices for incorporating this research into care.”