Correlation between Breast Arterial Calcification and the 10-year fatal cardiovascular risk by means of the SCORE Risk System

Breast arterial calcifications on mammography: a new marker of cardiovascular risk in asymptomatic middle age women?

OBJECTIVES

To determine whether breast arterial calcification (BAC) detected on mammography can predict the presence of coronary artery calcification (CAC) on CT in women.

METHODS

Women explored with both mammography and thoracic CT from 2009 to 2018 were retrospectively included. Women were separated in 3 categories (no BAC, few BAC, and marked BAC) using a specific 12-point scale. Similar scale was used to evaluate the amount of CAC on CT. The mean sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of BAC for the detection of CAC were calculated. Statistical significance was assessed with Pearson's chi-squared test and Fisher's exact test as appropriate.

RESULTS

A total of 507 women (mean age: 62 years ± 16) were included. Patients with high amount of BAC were older (72 ± 11 vs. 59 ± 15 years old; p < .0001), were more frequently hypertensive (66% vs. 31%; p < .0001), and had more frequently renal failure (21% vs. 6%; p < .0003) than patients without BAC. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of BAC for the detection of women with marked CAC were 53.1%, 87.6%, 55.0%, 86.7%, and 79.9%, respectively. The highest diagnostic accuracy was obtained in patients under 60 years: 84.2% for detection of CAC and 93.2% for detection of women with marked CAC.

CONCLUSION

The presence of BAC on mammography was linked to the presence of CAC and may be used as a cardiovascular marker in patient less than 60 years.

KEY POINTS

• The diagnostic accuracy of breast arterial calcification (BAC) to detect the presence of coronary artery calcification (CAC) was 70.4% and reached to 79.9% to detect women with high amount of CAC. • Highest diagnostic accuracy of BAC to detect CAC (93.2%) was noticed in women under 60 years. • The presence of BAC on mammography may be used as a cardiovascular risk marker in women, especially under 60 years.

Is breast arterial calcification associated with coronary artery disease?-A systematic review and meta-analysis

BACKGROUND

There is increasing evidence that breast arterial calcification (BAC), an incidental finding on 3-29% of mammograms, could be used to screen for coronary artery disease (CAD). We conducted a systematic review to assess the associations between BAC and CAD and its risk factors (hypertension, hypercholesterolemia, diabetes mellitus and smoking).

METHODS AND FINDINGS

MEDLINE and EMBASE databases and references of relevant papers were searched up to 18 February 2020 for English language studies that evaluated the associations of BAC and CAD and its risk factors. A single reviewer extracted all data and assessed study quality with verification by another independent reviewer, if required. Across 31 studies (n = 35,583; 3 longitudinal and 28 cross-sectional studies) that examined the association of BAC and CAD, the OR was 2.61 (95% CI 2.12-3.21; I2 = 71%). Sub-analysis of studies that graded BAC severity using the 4- (4 studies) or 12-point scale systems (3 studies) revealed an association with CAD and moderate-severe BAC (OR 4.83 (95%CI 1.50-15.54) and OR 2.95 (95%CI 1.49-5.84), respectively) but not mild BAC (OR 2.04 (95%CI 0.82-5.05) and OR 1.08 (95%CI 0.42-2.75), respectively). BAC was associated with hypertension (42 studies; n = 32,646; OR 1.80; 95% CI 1.47-2.21; I2 = 85%) and diabetes mellitus (51 studies; n = 53,464; OR 2.17; 95% CI 1.82-2.59; I2 = 75%) but not with hypercholesterolemia (OR 1.31; 95%CI 0.97-1.77; I2 = 67%). Smoking was inversely associated with BAC (35 studies; n = 40,002; OR 0.54; 95% CI 0.42-0.70; I2 = 83%). Studies mostly included symptomatic women. Marked heterogeneity existed and publication bias may be present.

CONCLUSIONS

BAC is associated with CAD, diabetes mellitus and hypertension and inversely associated with smoking. Whether BAC could screen for CAD cannot be determined from current published data due to the lack of larger prospective studies. A consensus approach to quantifying BAC may also facilitate further translation into clinical care. PROSPERO: CRD42020141644.