What your mammogram can tell you about your heart

By Eva Martin, MD of Elm Tree Medical Inc.

We all know that mammograms can detect breast cancer, but new research is revealing yet another treasure trove of information in mammograms. A finding called “Breast Arterial Calcifications” can be seen on mammograms, but currently, radiologists are not quantifying it or reporting it.  Read on to learn more about Breast Arterial Calcifications, known as BAC, and how it may help women predict their risk of heart disease in the future.

The BAC: Breast Arterial Calcifications refer to calcifications in the tiny arteries of the breast. The little calcifications show up white on mammography. Radiologists can count the number of little vessels that have calcifications, measure the length of the segments involved, and how dense the calcifications are. Using this information, the radiologist can give a BAC score from 1 to 12, with 1 being the least severe and 12 being the most severe.

The Study: Dr. Laurie Margolies, the director of breast imaging at Mt. Sinai Hospital in New York City, led the premier clinical trial studying BAC. 292 women underwent their normal, digital mammograms and a chest CT in the same year. The women were 61 years of age on average, and none had been diagnosed coronary artery disease. Some did have risk factors for heart disease, however, like hypertension, high lipids, diabetes, smoking, and chronic kidney disease. 42.5% of the women in the study had BAC present on their mammograms. The BAC score tended to increase with age. A high BAC score was associated with three times the risk of coronary artery calcifications. Dr. Margolies and her colleagues compared the BAC score with two commonly used scoring systems for estimating heart disease risk: The Framingham Risk Score and the 2013 Cholesterol Guidelines Pooled Cohort Equation. There was some disagreement in deciding which women were low-, medium-, and high-risk using different scoring systems. Overall, the risk levels matched a little more than half the time. However, the BAC score correlated with cardiovascular risk as well as The Framingham Risk Score and a little better than the 2013 Cholesterol Guidelines Pooled Cohort Equation. Furthermore, if researchers added the information gleaned from the BAC to the other scoring systems, the extra information made the scores even better at predicting cardiovascular risk.

The Next Steps: Heart disease kills ten times more women than breast cancer. Dr. Nasir of Baptist Health South Florida and Dr. McEvoy of Johns Hopkins Medical Center recently published an opinion article urging doctors to start using BAC to predict cardiovascular risk now. They believe that doctors should start using this important information as soon as possible, not wait for more clinical trials to validate it. They acknowledge that it is not yet known how best to use BAC, for instance, whether a high score should trigger more testing or a preventative treatment. But, they urge radiologists to start reporting the BAC score with mammograms so the information will be available to patients and doctors.