Screening Mammography and Breast Arterial Calcification: What a New Study Reveals

In a new study, researchers assessed the prevalence of breast arterial calcification (BAC) and contributing risk factors in a racially and ethnically diverse population of over 17,000 patients who had screening mammography exams.

Performing a retrospective review of charts from 17,237 patients (mean age of 59.75 years and average body mass index of 28.61) who had screening mammography, the study authors found a 12.3 percent prevalence of BAC, which has been associated with coronary artery disease.

Hispanic women, who comprised 40.58 percent of the study population, were 2.67 times more likely than non-Hispanic women to have positive BAC findings, according to the authors of the study, which was published in the Annals of Epidemiology. The researchers said Black or African-American women, who comprised 28.38 percent of the study population, were 12 percent more likely to have positive BAC findings.

Similar to findings from other studies, the prevalence of positive BAC findings doubled for every decade of life between the ages of 45 and 84. The study authors noted that women between the ages of 45 and 54 were 2.22 times more likely to have positive BAC findings than patients 44 years of age or younger. Women between 55 and 64 years of age were 5.98 times more likely to have positive BAC findings, according to the study.

In addition to screening for breast cancer, the researchers emphasized that annual mammograms provide a viable mechanism for screening and educating higher-risk women on BAC.

“This dual function can be carried out without additional radiation to women, the patient’s mammogram appointment would not take any longer, and assessing BAC would add minimal time to the interpretation and reporting tasks of the breast radiologist,” wrote study co-author Laurie Margolies, M.D., the director of Breast Imaging at the Icahn School of Medicine at Mount Sinai, and colleagues.

The researchers also found that premenopausal women, women who had not given birth and those taking hormone replacement therapy were less likely to have positive BAC findings. Women with breast implants and those with dense breasts also had a lower likelihood of positive BAC results, according to the study.

“One could hypothesize that our breast-specific findings (density, implants) are somehow related to masking of some faint vascular calcifications by dense breast tissue and the limitations of post-implant mammograms which do not include as much breast tissue as standard mammograms,” noted Margolies and colleagues.

In regard to limitations of the study, the authors said the cross-sectional analyses drawn from their retrospective chart review prohibit any causal conclusions from the study findings. The study also did not address breast feeding history, which may be associated with BAC, nor the severity of BAC, according to the study authors.

Margolies and colleagues suggested that future research should integrate questions about cardiovascular risk factors into pre-mammography patient questionnaires, and provide more nuanced, inclusive options for self-identification of race and ethnicity.