Breast Arterial Calcification as a Risk Marker for Cardiovascular Disease

Introduction to Breast Arterial Calcification

Breast arterial calcification (BAC) is a significant independent risk marker for cardiovascular disease (CVD) and should be considered a risk-enhancing factor for atherosclerotic cardiovascular disease (ASCVD) among women undergoing mammography 1, 2
BAC refers to medial calcification in the breast arteries that is commonly detected as an incidental finding during routine mammography screening 2
BAC involves medial calcium deposits leading to arterial stiffening and is more closely related to comorbidities such as diabetes and hypertension, unlike coronary artery calcification (CAC) which represents intimal arterial calcium deposits 1
BAC is present in approximately 26% of women aged 60-79 years undergoing screening mammography 1, 2

BAC presence is significantly associated with increased hazard of ASCVD (HR 1.51 [95% CI 1.08-2.11]) after adjustment for traditional cardiovascular risk factors 1, 2
BAC provides additional risk stratification beyond the pooled cohort equation, with an overall net reclassification improvement of 0.12 (95% CI 0.03-0.14) 1
BAC status can help identify women who may benefit from more aggressive cardiovascular risk management 1, 2

Women with BAC who fall into borderline or intermediate ASCVD risk categories may require more aggressive treatment 1, 2
Similarly, women with BAC who are already at high risk may need to have their therapy intensified 1, 2
Artificial intelligence algorithms can now quantify BAC, making it feasible to incorporate this information into clinical risk assessment 3

BAC and CAC have different causes and pathophysiology, suggesting that BAC may contribute to cardiovascular disease through a pathway distinct from the intimal atherosclerotic process 1
Given the widespread use of mammography screening (approximately 70% of women in Europe), incorporating BAC assessment into cardiovascular risk screening could have substantial public health impact 3

BAC should be reported on mammography reports as it provides valuable cardiovascular risk information 1, 2, 4
Patients with BAC on mammography should be considered for cardiovascular risk assessment and appropriate preventive interventions 1, 2
BAC can be used alongside traditional risk factors to better personalize cardiovascular risk assessment in women 3