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Zaki-Metias KM, McKee H, Applewhaite C, Davis MK, Keyes M, LeVasseur N, Nguyen ET, Seely JM, Yong-Hing CJ. Breast Arterial Calcifications on Mammography: Awareness and Reporting Preferences Amongst Referring Physicians in Canada. Can Assoc Radiol J 2024:8465371241262292. [PMID: 39039993 DOI: 10.1177/08465371241262292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
Purpose: Breast arterial calcifications (BAC) on mammography have been correlated with increased cardiovascular risk. The Canadian Society of Breast Imaging released a position statement on BAC reporting in January 2023. This study evaluates the awareness of the clinical significance of BAC and reporting preferences of referring physicians in Canada. Methods: A 15-question survey was distributed to Canadian physicians who may review mammography results via regional and subspecialty associations and on social media following local institutional ethical approval. Responses were collected over 10 weeks from February to April 2023. Results: Seventy-two complete responses were obtained. We are unable to determine the response rate, given the means of distribution. Only 17% (12/72) of responding physicians were previously aware of the association between BAC and increased cardiovascular risk, and 51% (37/72) preferred the inclusion of BAC in the mammography report. Fifty-six percent (40/72) indicated that BAC reporting would prompt further investigation, and 63% (45/72) would inform patients that their mammogram showed evidence of BAC. Sixty-nine percent (50/72) would find grading of BAC beneficial and 71% (51/72) agreed that there is a need for national guidelines. Conclusion: Less than a quarter of responding Canadian referring physicians were previously aware of the association between BAC and cardiovascular risk, although half of respondents indicated a preference for BAC reporting on mammography. Most participating physicians would inform their patients of the presence of BAC and consider further cardiovascular risk management. There was consensus that a national BAC grading system and clinical management guidelines would be beneficial.
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Affiliation(s)
- Kaitlin M Zaki-Metias
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Hayley McKee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Margot K Davis
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Mira Keyes
- Radiation Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Elsie T Nguyen
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
| | - Jean M Seely
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Charlotte J Yong-Hing
- Diagnostic Imaging, BC Cancer, Vancouver, BC, Canada
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Vincoff NS, Ramos AA, Duran-Pilarte E, Derobertis A, Daniel W, Bajwa BN, Petrone E, Kline M, Pavel DM, Rosen SE. Patient Notification About Breast Arterial Calcification on Mammography: Empowering Women With Information About Cardiovascular Risk. JOURNAL OF BREAST IMAGING 2023; 5:658-665. [PMID: 38141233 DOI: 10.1093/jbi/wbad063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To assess the impact of informing women about the presence of breast arterial calcification (BAC) on mammography by determining whether those notified about the presence of BAC would seek cardiovascular evaluation. METHODS This IRB-approved prospective study included 494 patients who underwent screening mammography between June 8, 2021, and April 22, 2022. Mammograms were reviewed by a radiologist, and patients were notified via e-mail about the presence or absence of BAC. Patients with BAC were advised to discuss the results with their physicians and were surveyed 3 months later. Frequencies and proportions were calculated for study participation, presence of BAC, survey participation, health actions, and perceptions. Confidence intervals were calculated for proportions of health actions and perceptions. RESULTS Of 494 study participants, 68/494 (13.8%; 95% CI: 10.9%-17.1%) had BAC detected on mammography and 42/68 (61.8%; 95% CI: 61.1%-62.1%) with BAC completed the follow-up survey at 3 months. Of these 42 survey respondents, 24/42 (57.1%; 95% CI: 41.1%-72.3%) reported discussing results with their primary care physician (PCP) or a cardiologist. In addition, 34/42 (81.0%; 95% CI: 65.9%-91.4%) reported finding it helpful to receive information about BAC and 32/42 (76.2%; 95% CI: 60.6%-88.0%) believed all women should be informed about BAC after mammography. CONCLUSION After notification about the presence of BAC on screening mammography, the majority (57.1%) of survey respondents reported discussing the results with a PCP or cardiologist. These results suggest that providing mammography patients with information about BAC may promote preventive cardiovascular health.
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Affiliation(s)
- Nina S Vincoff
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Aderonke A Ramos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | | | - Alicia Derobertis
- New-York Presbyterian Healthcare System Inc, Department of Radiology, New York, NY, USA
| | - Woodlynn Daniel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Bakhtawar N Bajwa
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Eric Petrone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Myriam Kline
- Northwell Health Feinstein Institutes for Medical Research, Department of Statistics, Manhasset, NY, USA
| | - Donatella M Pavel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Manhasset, NY, USA
| | - Stacey E Rosen
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Cardiology, Manhasset, NY, USA
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Heaney RM, Zaki-Metias KM, McKee H, Wang H, Ogunde B, Yong-Hing CJ, Freitas V, Ghai S, Seely JM, Nguyen ET. Correlation Between Breast Arterial Calcifications and Higher Cardiovascular Risk: Awareness and Attitudes Amongst Canadian Radiologists Who Report Mammography. Can Assoc Radiol J 2023; 74:582-591. [PMID: 36541871 DOI: 10.1177/08465371221140347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Breast arterial calcification (BAC) on mammography correlates with increased cardiovascular risk. Reporting BAC is not standard practice. Our study evaluates the awareness of Canadian radiologists who report mammography of the clinical significance of BAC and their attitudes towards reporting BAC compared to their European and American counterparts. Methods: Following local institutional ethics approval, a 25 question survey (SurveyMonkey) was disseminated to Canadian radiologists via provincial and national society email lists. Responses were collected over 5 weeks (April-June 2022). Results: One hundred and eighty-six complete responses were collected. Sixty percent (112/186) were aware of the association between BAC and cardiovascular risk and 16% (29/186) document its presence in mammogram reports. Thirty five percent (65/186) occasionally document BAC if severe or in a young patient. Four percent (7/186) had local departmental guidelines on BAC reporting and 82% (153/186) agreed there is a need for national BAC reporting guidelines. Fewer Canadian radiologists were aware of the association between BAC and cardiovascular risk compared to European radiologists (60% vs 81%), report the presence of BAC compared to both European (15% vs 62%) and American (15% vs 35%) radiologists, and inform the patient of the presence of BAC compared to European radiologists (1% vs 46%). Conclusion: Canadian radiologists who report mammography were less aware of the association between BAC and cardiovascular risk than their European and American counterparts and were less likely to document the presence of BAC. Given the correlation of BAC with increased cardiovascular event risk, there is increased need for awareness as well as national BAC reporting guidelines.
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Affiliation(s)
- Roisin M Heaney
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
| | - Kaitlin M Zaki-Metias
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Hayley McKee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Huijuan Wang
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Barakat Ogunde
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Charlotte J Yong-Hing
- Diagnostic Imaging, BC Cancer, Vancouver, BC, Canada
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging, Princess Margaret Hospital, Toronto, ON, Canada
| | - Sandeep Ghai
- Joint Department of Medical Imaging, Princess Margaret Hospital, Toronto, ON, Canada
| | - Jean M Seely
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Elsie T Nguyen
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
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Relationship between Arterial Calcifications on Mammograms and Cardiovascular Events: A Twenty-Three Year Follow-Up Retrospective Cohort Study. Biomedicines 2022; 10:biomedicines10123227. [PMID: 36551983 PMCID: PMC9776346 DOI: 10.3390/biomedicines10123227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Breast arterial calcifications (BAC) have been associated with cardiovascular diseases. We aimed to examine whether the presence of BAC could predict the development of cardiovascular events in the very long term, as evidence has suggested. PATIENTS AND METHODS We conducted a 23-year follow-up retrospective cohort study considering women specifically studied for breast cancer. After reviewing the mammograms of 1759 women, we selected 128 patients with BAC and an equal number of women without BAC. RESULTS Women with BAC had higher relative risk (RR) for cardiovascular events, globally 1.66 (95% CI): 1.31-2.10 vs. 0.53 (0.39-0.72), and individually for ischemic heart disease 3.25 (1.53-6.90) vs. 0.85 (0.77-0.94), hypertensive heart disease 2.85 (1.59-5.09) vs. 0.79 (0.69-0.89), valvular heart disease 2.19 (1.28-3.75) vs. 0.83 (0.73-0.94), congestive heart failure 2.06 (1.19-3.56) vs. 0.85 (0.75-0.96), peripheral vascular disease 2.8 (1.42-5.52) vs. 0.85 (0.76-0.94), atrial fibrillation 1.83 (1.09-3.08) vs. 0.86 (0.76-0.98), and lacunar infarction 2.23 (1.21-4.09) vs. 0.86 (0.77-0.96). Cox's multivariate analysis, also considering classical risk factors, indicated that this BAC was significantly and independently associated with survival (both cardiovascular event-free and specific survival; 1.94 (1.38-2.73) and 6.6 (2.4-18.4)). CONCLUSIONS Our data confirm the strong association of BAC on mammograms and the development cardiovascular events, but also evidence the association of BAC with cardiovascular event-free and specific survival.
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Cameron NA, Khan SS. Leveraging Mammography as a Unique Opportunity for Cardiovascular Health Promotion. Circ Cardiovasc Imaging 2022; 15:e013977. [PMID: 35290076 PMCID: PMC8931850 DOI: 10.1161/circimaging.122.013977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Natalie A Cameron
- Division of General Internal Medicine and Geriatrics (N.A.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sadiya S Khan
- Division of Cardiology (S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Medicine and Department of Preventive Medicine (S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL
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