Can Mammograms Help Detect Heart Disease Risk? A New Look at Breast Arterial Calcifications

By | November 2, 2024

As more people get mammograms every year to screen for breast cancer, an additional benefit may be emerging: heart disease risk detection. With advanced technology and artificial intelligence, some imaging centers now offer screenings for cardiovascular risks based on breast arterial calcification visible in mammogram images. This additional test, offered by some radiology practices, could provide an early warning for cardiovascular disease, the leading cause of death among women in the United States. But does it provide reliable information, and how can it impact patient care?

What Is Breast Arterial Calcification?

During a mammogram, X-ray images are taken to detect breast cancer by revealing any abnormalities in breast tissue. However, these images can also show calcification in breast arteries, which appear as small white lines. Breast arterial calcifications (BAC) are different from coronary artery calcifications, which are well-known markers for cardiovascular disease, but research indicates BAC might also signal an elevated risk for cardiovascular issues.

Breast arterial calcification has long been seen as an incidental finding, often unrelated to breast cancer. While some radiologists note BAC presence, the information typically isn’t shared with patients. Now, some clinics are making this additional analysis available for a fee, using AI to evaluate the mammogram for BAC and offering patients the results.

Key Facts on Mammograms and Heart Disease Screening

  • Heart Disease Prevalence: Heart disease is the top cause of death among women in the U.S., causing over 300,000 deaths annually.
  • Annual Screenings: Millions of women undergo annual mammograms, mostly for breast cancer detection, which opens the possibility for additional screenings.
  • Artificial Intelligence (AI): Some radiology centers now use AI to identify BAC on mammograms, potentially signaling a cardiovascular risk.
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How Does BAC Screening Work?

In practices offering BAC analysis, such as Washington Radiology, patients can opt to have their mammogram images reviewed for BAC. For an additional fee, AI software analyzes the images for calcification in the breast arteries, which could indicate an increased risk of cardiovascular disease. Washington Radiology and other clinics offer this AI-driven BAC analysis as part of a program called “Mammo+Heart.”

Dr. Islamiat Ego-Osuala, a breast imaging radiologist at Washington Radiology, notes the potential of AI in radiology, highlighting the value of using mammograms to assess cardiovascular health. However, this approach has stirred debate among experts regarding its reliability and accuracy in assessing heart disease risk.

Current Research and Expert Opinions on BAC and Heart Health

Although some studies have identified a link between BAC and heart disease, further research is necessary to clarify the relationship. Coronary artery calcification is a strong indicator of heart disease risk, but the link between BAC and cardiovascular risk remains less certain.

Dr. Sadiya Khan, a preventive cardiologist at Northwestern Medicine, expressed a cautious outlook, stating, “It’s exciting but requires cautious interpretation.” While BAC may be associated with heart disease, most cardiovascular events in studies occur in women without BAC. This suggests that while BAC may provide valuable information, it is not a comprehensive tool for heart disease risk assessment.

Key Points from Recent Research

  • Study Findings: Research on postmenopausal women showed that 26% had BAC, correlating with a 23% increase in general heart disease risk and a 51% increase in heart attack or stroke risk.
  • Limitations: Most cardiovascular events occurred in women without BAC, indicating that BAC alone might not be a definitive predictor of heart disease.
  • Need for Further Research: Experts advocate for more studies, specifically randomized controlled trials, to determine BAC screening’s actual effectiveness in predicting and preventing heart disease.
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Pros and Cons of BAC Screening in Mammograms

Benefits of BAC Screening

  • Additional Heart Health Insight: BAC screening can offer an early warning for heart disease, giving patients and their doctors more information to manage heart health.
  • Increased Awareness: Screening for BAC may encourage discussions about heart disease, especially as many women may be unaware of their cardiovascular risk factors.
  • Accessible Screening: Mammograms are already a regular annual test for millions of women, so adding BAC screening could be a convenient option.

Limitations and Concerns

  • Accuracy Uncertainty: Experts like Dr. Greg Sorensen from RadNet caution that BAC screening may not deliver consistent value, as BAC is not the same as coronary artery calcification.
  • Cost of Screening: Some clinics charge extra for BAC analysis, which may limit accessibility for certain patients.
  • Incomplete Risk Assessment: Women without BAC can still be at risk for heart disease, meaning this screening cannot replace traditional heart health assessments.

Potential Impact on Patient Care

Some health centers, like the Lynn Women’s Health and Wellness Institute in Florida, already include BAC screenings with all mammograms. If BAC is detected, patients are referred to a cardiologist for further evaluation and counseling on heart health. Dr. Heather Johnson, a preventive cardiologist at the institute, sees BAC screening as an opportunity to create “a communication pathway” for discussing cardiovascular health.

A study found that 57% of women who learned about their BAC results from a mammogram discussed the findings with their primary doctor or cardiologist. Dr. Laura Heacock, a breast imaging specialist at NYU Langone Health, emphasizes the importance of these conversations, noting that BAC screening opens the door to more proactive heart health management.

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What’s Next in Research?

Experts agree that additional studies are essential to confirm BAC screening’s long-term value. Dr. Khan and others advocate for longer-term trials to understand how BAC screening might impact patient outcomes, reduce heart disease risks, and fit into overall cardiovascular care.

Future research should address:

  • Mechanisms Behind BAC: Studies need to explore why BAC may indicate cardiovascular risk and if it relates to other heart disease markers, like coronary artery calcification.
  • Broader Populations: Trials should include a diverse range of patients, including women without known heart disease risks.
  • Impact on Patient Outcomes: Research should confirm whether BAC screening improves heart health outcomes or prevents cardiovascular events.

Conclusion

Using mammograms to detect heart disease risk is an exciting new frontier, but caution is necessary. While BAC screening provides an additional insight into cardiovascular health, it remains just one tool among many in heart disease assessment. Discussing results with healthcare providers can be a valuable step, but BAC screening should not replace comprehensive heart health evaluations.

As more research unfolds, BAC screening could become an essential part of preventive care for women, adding another dimension to annual mammograms and supporting proactive heart health strategies.

Editor’s Note: This article is a reprint. It was originally published here: Health News