A number of cardiovascular events occur in women with a low estimated atherosclerotic cardiovascular disease risk (10-year estimated risk below 8%). This means there are women who are having cardiovascular events but haven’t been identified as being at high risk using current risk factor screening tools. There is active research into how better to identify these patients before their cardiovascular events take place – and potentially prevent disease before it occurs by better defining risk strata and utilizing more aggressive preventative therapies like statins in high-risk patients. 

Observational studies have shown that the presence of breast arterial calcifications (BAC) may provide important prognostic information. For example, in a study of over 5000 women aged 60-79, BAC was significantly associated with an increased hazard of incident atherosclerotic and global cardiovascular disease. BAC are common – about 1 in 4 women have BAC on their mammograms. BAC are calcifications found within the small to medium-sized branches of the internal mammary and long thoracic arteries of the breasts. These are calcifications of the medial layer of the arteries, not the intimal layer as is commonly seen with atherosclerotic coronary artery or peripheral vascular calcifications. BAC may form with chronic exposure to known cardiovascular risk factors like obesity, diabetes, and hypertension. 

Researchers don’t yet understand why the presence of arterial calcifications on a mammogram signifies an increased risk of cardiovascular disease, but they are emerging as a possible new risk marker for cardiovascular disease.

Many radiologists do not report BAC on mammogram reports unless they are severe or the patient is below a certain age. This is because, to date, there has been no clear downstream recommendation to give to ordering physicians regarding the finding. However, recent patient preference studies indicate that the majority of women would like to know if they have BAC or not, and would be willing to speak to their doctor about cardiovascular risk factors and lifestyle modifications to decrease their risks.

If you are interested in learning if you have BAC on your mammogram, ask Dr. Lizer at your next visit.