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How Predictive Is Breast Arterial Calcification of Cardiovascular Disease and Risk Factors When Found at Screening Mammography?

¹ Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
² Cambridge Breast Unit, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge, CB2 2QQ, United Kingdom.
³ Strangeways Research Laboratory, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.
⁴ Department of Radiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
⁵ Clinical Gerontology Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.

OBJECTIVE. The purpose of this study was to examine the relationship between breast arterial calcification (BAC), commonly found on mammography, and cardiovascular disease and its risk factors.

SUBJECTS AND METHODS. The study population, nested within the European Prospective Investigation of Cancer-Norfolk (EPIC-Norfolk) cohort study, consisted of 1,590 women older than 55 years, not taking hormone replacement therapy, and with available screening mammograms. Mammograms were coded by three radiologists for presence or absence of BAC. History of coronary heart disease (CHD), stroke, and diabetes and risk factors for cardiovascular disease (including smoking status, body mass index [BMI], blood pressure, diabetes, and glycosylated hemoglobin [HbA_1c]) were independently measured from health examinations in the EPIC study.

RESULTS. The prevalence of BAC was 16.0%. Women with BAC were significantly older than those without it. BAC was associated with prevalent CHD, but not stroke. The odds ratio of having CHD was 2.54 (95% confidence interval, 1.03-6.30). The sensitivity and specificity were 32.4% and 85.5%, respectively. Except for smoking, which showed an inverse association, there was no consistent significant association of BAC with cardiovascular disease risk factors including BMI, diabetes, HbA_1c, or lipids.

CONCLUSION. BAC found on mammograms was associated with prevalent CHD after adjustment for age, but with low sensitivity. BAC may provide additional information toward identifying cardiovascular disease risk among otherwise healthy women.

Keywords: breast • breast arterial calcification • cardiovascular disease • mammography

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