Arterial calcium findings on mammograms can predict heart disease risk

The question may not be whether breast arterial calcification provides useful information, but how to most efficiently incorporate it into routine clinical practice now, Dr. Khurram Nassir and Dr. John W. McEvoy wrote in an accompanying editorial.

BAC has always been visible on mammograms, but it’s never been clinically leveraged.

“Despite the fact that a tremendous amount of literature in the past has pointed attention that BAC significantly increases vulnerability to … myocardial infarction, stroke, peripheral artery disease, and even heart failure,” no individual or society has taken up the challenge of creating a standardized measure that can be consistently employed in clinical assessments.

This failure by the medical community is “disappointing,” they noted – but perhaps not unexpected. Cries for supporting clinical trials frequently hamper movement on new ideas, even those that are already well grounded in science.

“Rather than another outcome study, our stakeholders are more likely to cherish investigations designed to explore better health-delivery models using information” like the BAC score, they said. “The conventional response ‘lack of clinical trial’ should not be allowed to justify current inertia which has already impeded constructive dialogue.”

More studies are needed to fully flesh out the relationship and how to best employ BAC data, they agreed, but the relationship is solid and should be recognized as useful.

“Whether the best use of BAC is to trigger additional testing or directly inform preventive treatment decisions, either by flagging high-risk women to their providers or by reclassifying traditional [atherosclerotic cardiovascular disease] risk estimates is worth further discussion,” Dr. Nasir and Dr. McEvoy wrote. But for now, the report provides strong motivation for the widespread documentation of BAC in mammography reports, thereby improving the education of primary care and radiology providers regarding the link between BAC and atherosclerotic coronary vascular disease (JACC Cardiovasc Imag. 2016 Mar 24. doi: 10.1016/j.jcmg.2015.09.017).

Dr. Nasir is director of the High-risk Cardiovascular Disease Clinic at Baptist Health South Florida, Miami. Dr. McEvoy is a clinical and research fellow at the Johns Hopkins Medical Center Cardiology and Vascular Institute, Baltimore.