The association of breast arterial calcification and coronary heart disease.
OBJECTIVE
To estimate whether mammography can be an early, valid tool for predicting the development of coronary heart disease (CHD) in women.


METHODS
Women presenting for routine mammograms between June and August 2004 were recruited for the study. Baseline data collected included risk factors and family history of heart disease, as well as any cardiac events experienced by the patient. Similar follow-up data were collected during subsequent years, and these patient-completed surveys were correlated with the baseline mammograms screened for breast arterial calcifications.


RESULTS
Throughout the 5-year follow-up, CHD was present in 20.8% of women who screened positive for breast arterial calcification and in 5.4% of who screened negative for breast arterial calcification (P<.001). Among women who did not have CHD at baseline, breast arterial calcification-positive women were more likely to develop CHD or a stroke than those who were breast arterial calcification-negative (6.3% compared with 2.3%, P=.003; and 58.3% compared with 13.3%, P<.001), respectively. These results remained significant even when controlling for age.


CONCLUSIONS
The presence of breast arterial calcifications on mammograms indicates a significantly increased risk of developing CHD or a stroke. These results suggest that breast arterial calcifications should be routinely reported on mammograms and viewed as a marker for the development of CHD.


METHODS
II.
From the Departments of Obstetrics and Gynecology and Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; the Departments of Obstetrics and Gynecology and Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; and the School of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
Peter F
PF
Schnatz
Kimberly A
KA
Marakovits
David M
DM
O'Sullivan
D000328:Adult; D000368:Aged; D001940:Breast / Q000098:blood supply*; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology
Stampfer MJ, Colditz GA, Willett WC. Menopause and heart disease: a review. Ann N Y Acad Sci 1990;592:193–203.
Zouaoui Boudijeltia K, Gregoir C, Guillaume M, Remacle C, Piro P, Garbar C, et al. Antigens and granularity of blood monocytes in relation to inflammatory markers and lipids in postmenopausal women. Maturitas 2006;55:132–41.
Kannel WB, Hjortland MC, Mcnamara PM, Gordon T. Menopause and risk of cardiovascular disease: the Framingham study. Ann Intern Med 1976;85:447–52.
Gordon T, Kannel WB, Hjortland MC, McNamara PM. Menopause and coronary heart disease: the Framingham study. Ann Intern Med 1978;89:157–61.
Bush TL. The epidemiology of cardiovascular disease in postmenopausal women. Ann N Y Acad Sci 1990;592:263–71.
Colditz GA, Willett WC, Stampfer MJ, Rosner B, Spiezer FE, Hennekens CH. Menopause and the risk of coronary heart disease in women. N Engl J Med 1987;316:1105–10.
Eaker ED, Chesebro JH, Sacks FM, Wenger NK, Whisnant JP, Winston M. Cardiovascular disease in women. Circulation 1993;88(4 pt 1):1999–2009.
Moore EH, Greenberg RW, Merrick SH, Miller SW, McLoud TC, Shepard JA. Coronary artery calcifications: significance of incidental detection on CT scans. Radiology 1989;172:711–6.
Witteman JC, Kok FJ, van Saase JL, Valkenburg HA. Aortic calcification as a predictor of cardiovascular mortality. Lancet 1986;2:1120–2.
Witteman JCM, Kannel WB, Wolf PA, Grobbee DE, Hofman A, D'Agostino RB, et al. Aortic calcified plaques and cardiovascular disease (the Framingham Study). Am J Cardiol 1990;66:1060–4.
Sickles EA, Galvin HB. Breast arterial calcification in association with diabetes mellitus: too weak a correlation to have clinical utility. Radiology 1985;155:577–9.
Kemmeren JM, Beijernick D, van Noord PA, Banga JD, Deurenberg JJ, Pameijer FA, et al. Breast arterial calcifications: association with diabetes mellitus and cardiovascular mortality. Radiolology 1999;201:75–8.
Rotter MA, Schnatz PF, Currier AA Jr, O'Sullivan DM. Breast arterial calcifications (BACs) found on screening mammography and their association with cardiovascular disease. Menopause 2008;15:276–81.
Kataoka M, Warren R, Luben R, Camus J, Denton E, Sala E, et al. How predictive is breast arterial calcification of cardiovascular disease and risk factors when found at screening mammography? AJR Am J Roentgenol 2006;187:73–80.
Maas AH, van der Schouw YT, Atsma F, Beijerinck D, Deurenberg JJ, Mali WP, et al. Breast arterial calcifications are correlated with subsequent development of coronary artery calcifications, but their aetiology is predominantly different. Eur J Radiol 2007;63:396–400.
Dale PS, Mascarhenas C, Richards M, Mackie G. Mammography as a screening tool for coronary artery disease. J Surg Res 2008;148:1–6.
Reddy J, Son H, Smith SJ, Paultre F, Mosca L. Prevalence of breast arterial calcifications in an ethnically diverse population of women. Ann Epidemiol 2005;15:344–50.
Taçskin F, Akdilli A, Karaman C, Unsal A, Köseoğlu K, Ergin F. Mammographically detected breast arterial calcifications: indicators for arteriosclerotic diseases? Eur J Radiol 2006;60:250–5.
Dale PS, Richards M, Mackie GC. Vascular calcifications on screening mammography identify women with increased risk of coronary artery disease and diabetes. Am J Surg 2008;196:537–40.
Kemmeren JM, van Noord PA, Beijerinck D, Fracheboud J, Banga JD, van der Graaf Y. Arterial calcification found on breast cancer screening mammograms and cardiovascular mortality in women: The DOM Project. Doorlopend Onderzoek Morbiditeit en Mortaliteit. Am J Epidemiol 1998;147:333–41.
Fiuza Ferreira EM, Szejnfeld J, Faintuch S. Correlation between intramammary arterial calcifications and CAD. Acad Radiol 2007;14:144–50.
Ferreira JA, Pompei LM, Fernandes CE, Azevedo LH, Peixoto S. Breast arterial calcification is a predictive factor of cardiovascular disease in Brazilian postmenopausal women. Climacteric 2009;12:439–44.
US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009;151:716–26, W-236.
Schnatz PF, Rotter MA, Hadley S, Currier AA, O'Sullivan DM. Hormonal therapy is associated with a lower prevalence of breast arterial calcification on mammography. Maturitas 2007;57:154–60.
Baum JK, Comstock C, Joseph L. Intramammary arterial calcifications associated with diabetes. Radiology 1980;136:61–2.
Sickles EA. Breast calcifications: mammographic evaluation. Radiology 1986;160:289–93.
Crystal P, Crystal E, Leor J, Friger M, Katzinovitch G, Strano S. Breast artery calcium on routine mammography as a potential marker for increased risk of cardiovascular disease. Am J Cardiol 2000;86:216–7.
Henkin Y, Abu-Ful A, Shai I, Crystal P. Lack of association between breast artery calcification seen on mammography and coronary artery disease on angiography. J Med Screen 2003;10:139–42.
Schmitt EL, Westland M, Threatt BA. Relationship of mammographic intra-arterial calcifications and diabetes. South Med J 1984;77:988–9.