J Cardiovasc Imaging.  2018 Sep;26(3):125-134. 10.4250/jcvi.2018.26.e20.

Breast Arterial Calcification: A Potential Surrogate Marker for Cardiovascular Disease

• Suh JW
• Yun BL

• KMID: 2429853
• DOI: http://doi.org/10.4250/jcvi.2018.26.e20

Abstract

Breast arterial calcifications (BAC), frequently observed on screening mammography, have been considered as an incidental finding without increased risk for breast cancer. They are medial calcifications and therefore, are indicative of arteriosclerosis. Previous studies indicated that the risk factors of BAC partly overlap with those of cardiovascular disease (CVD), and the presence of BAC is associated with prevalent and incident CVD. This suggests that medial arterial calcification might contribute to CVD through a pathway distinct from the intimal atherosclerotic process. A recent study showed that the presence and severity of BAC are associated with the presence of coronary artery calcification or plaques on coronary computed tomography angiography in asymptomatic women aged more than 40 years. In addition, BAC provided an independent and incremental predictive value over conventional risk factors. Given that population-based mammography screening is currently recommended in asymptomatic women, the evaluation of BAC may be helpful in identifying high-risk women without additional cost or radiation exposure.

Keyword

Breast arterial calcification; Cardiovascular disease; Coronary artery calcification; Coronary artery disease

MeSH Terms

Angiography
Arteriosclerosis
Biomarkers*
Breast Neoplasms
Breast*
Cardiovascular Diseases*
Coronary Artery Disease
Coronary Vessels
Female
Humans
Incidental Findings
Mammography
Mass Screening
Radiation Exposure
Risk Factors
Biomarkers

Figure

• 

  Figure 1 Scoring system of breast arterial calcification (BAC) density. The calcification density of the vessel in the densest segment is scored using 4-step scale. White arrow indicates calcification segment. (A) 0, none, (B) 1, vessel wall calcification with clear visualization of the lumen and/or single wall calcination, (C) 2, vessel wall calcification with clouding of the lumen, (D) 3, dense vessel wall calcification without visualization of the lumen.

Reference

1. Yeboah J, Polonsky TS, Young R, et al. Utility of nontraditional risk markers in individuals ineligible for statin therapy according to the 2013 American College of Cardiology/American Heart Association Cholesterol Guidelines. Circulation. 2015; 132:916–922.

2. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63:2889–2934.

3. Yoon YE, Kim KM, Han JS, et al. Prediction of subclinical coronary artery disease with breast arterial calcification and low bone mass in asymptomatic women: Registry for the Women Health Cohort for Breast, Bone, and Coronary Artery Disease Study. JACC Cardiovasc Imaging. 2018; pii: S1936-878X30551-5.

4. Lee EH, Park B, Kim NS, et al. The Korean guideline for breast cancer screening. J Korean Med Assoc. 2015; 58:408–419.

5. Sickles EA, D'Orsi CJ, Bassett LW, et al. ACR BI-RADS®. Mammography. ACR BI-RADS®. Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology;2013. p. 5.

6. Polonsky TS, Greenland P. Breast arterial calcification: expanding the reach of cardiovascular prevention. Circulation. 2017; 135:499–501.

7. Hendriks EJ, de Jong PA, van der Graaf Y, et al. Breast arterial calcifications: a systematic review and meta-analysis of their determinants and their association with cardiovascular events. Atherosclerosis. 2015; 239:11–20.

8. Moshyedi AC, Puthawala AH, Kurland RJ, O'Leary DH. Breast arterial calcification: association with coronary artery disease. Work in progress. Radiology. 1995; 194:181–183.

9. Henkin Y, Abu-Ful A, Shai I, Crystal P. Lack of association between breast artery calcification seen on mammography and coronary artery disease on angiography. J Med Screen. 2003; 10:139–142.

10. Topal U, Kaderli A, Topal NB, et al. Relationship between the arterial calcification detected in mammography and coronary artery disease. Eur J Radiol. 2007; 63:391–395.

11. Fiuza Ferreira EM, Szejnfeld J, Faintuch S. Correlation between intramammary arterial calcifications and CAD. Acad Radiol. 2007; 14:144–150.

12. Penugonda N, Billecke SS, Yerkey MW, Rebner M, Marcovitz PA. Usefulness of breast arterial calcium detected on mammography for predicting coronary artery disease or cardiovascular events in women with angina pectoris and/or positive stress tests. Am J Cardiol. 2010; 105:359–361.

13. Zgheib MH, Buchbinder SS, Abi Rafeh N, et al. Breast arterial calcifications on mammograms do not predict coronary heart disease at coronary angiography. Radiology. 2010; 254:367–373.

14. Hekimoğlu B, Simşir BD, Oztürk E, Yücesoy C, Akdemir R. The association of intramammarian arterial calcifications detected on mammography with coronary artery disease and its risk factors. JBR-BTR. 2012; 95:229–234.

15. Ružičić D, Dobrić M, Vuković M, et al. The correlation of SYNTAX score by coronary angiography with breast arterial calcification by digital mammography. Clin Radiol. 2018; 73:454–459.

16. Pecchi A, Rossi R, Coppi F, Ligabue G, Modena MG, Romagnoli R. Association of breast arterial calcifications detected by mammography and coronary artery calcifications quantified by multislice CT in a population of post-menopausal women. Radiol Med. 2003; 106:305–312.

17. Maas AH, van der Schouw YT, Atsma F, et al. Breast arterial calcifications are correlated with subsequent development of coronary artery calcifications, but their aetiology is predominantly different. Eur J Radiol. 2007; 63:396–400.

18. Matsumura ME, Maksimik C, Martinez MW, et al. Breast artery calcium noted on screening mammography is predictive of high risk coronary calcium in asymptomatic women: a case control study. Vasa. 2013; 42:429–433.

19. Moradi M, Adibi A, Abedi M. Relationship between breast arterial calcification on mammography with CT calcium scoring and coronary CT angiography results. Adv Biomed Res. 2014; 3:79.

20. Newallo D, Meinel FG, Schoepf UJ, et al. Mammographic detection of breast arterial calcification as an independent predictor of coronary atherosclerotic disease in a single ethnic cohort of African American women. Atherosclerosis. 2015; 242:218–221.

21. Mostafavi L, Marfori W, Arellano C, et al. Prevalence of coronary artery disease evaluated by coronary CT angiography in women with mammographically detected breast arterial calcifications. PLoS One. 2015; 10:e0122289.

22. Chadashvili T, Litmanovich D, Hall F, Slanetz PJ. Do breast arterial calcifications on mammography predict elevated risk of coronary artery disease? Eur J Radiol. 2016; 85:1121–1124.

23. Margolies L, Salvatore M, Hecht HS, et al. Digital Mammography and Screening for Coronary Artery Disease. JACC Cardiovasc Imaging. 2016; 9:350–360.

24. Kelly B, Scanlan E, McNally S, Prichard R, Dodd J. Breast arterial calcification on screening mammography can predict clinically significant coronary artery disease (CAD) in the BreastCheck screening cohort. Eur J Surg Oncol. 2017; 43:S2.

25. Fathala A, Al Amer A, Shukri M, Abouzied MM, Alsugair A. The relationship between coronary artery calcification and myocardial perfusion in asymptomatic women. Ann Saudi Med. 2012; 32:378–383.

26. Abi Rafeh N, Castellanos MR, Khoueiry G, et al. Association between coronary artery disease diagnosed by coronary angiography and breast arterial calcifications on mammography: meta-analysis of the data. J Womens Health (Larchmt). 2012; 21:1053–1058.

27. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990; 15:827–832.

28. Hecht HS, Cronin P, Blaha MJ, et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Cardiovasc Comput Tomogr. 2017; 11:74–84.

29. Lakoski SG, Greenland P, Wong ND, et al. Coronary artery calcium scores and risk for cardiovascular events in women classified as “low risk” based on Framingham risk score: the multi-ethnic study of atherosclerosis (MESA). Arch Intern Med. 2007; 167:2437–2442.

30. Kim KP, Einstein AJ, Berrington de González A. Coronary artery calcification screening: estimated radiation dose and cancer risk. Arch Intern Med. 2009; 169:1188–1194.

31. Kondos GT, Hoff JA, Sevrukov A, et al. Electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5635 initially asymptomatic low- to intermediate-risk adults. Circulation. 2003; 107:2571–2576.

32. Taylor AJ, Bindeman J, Feuerstein I, et al. Community-based provision of statin and aspirin after the detection of coronary artery calcium within a community-based screening cohort. J Am Coll Cardiol. 2008; 51:1337–1341.

33. Ryan AJ, Choi AD, Choi BG, Lewis JF. Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women. Clin Cardiol. 2017; 40:648–653.

34. Kemmeren JM, van Noord PA, Beijerinck D, Fracheboud J, Banga JD, van der Graaf Y. Arterial calcification found on breast cancer screening mammograms and cardiovascular mortality in women: the DOM project. Am J Epidemiol. 1998; 147:333–341.

35. Iribarren C, Go AS, Tolstykh I, Sidney S, Johnston SC, Spring DB. Breast vascular calcification and risk of coronary heart disease, stroke, and heart failure. J Womens Health (Larchmt). 2004; 13:381–389.

36. Schnatz PF, Marakovits KA, O'Sullivan DM. The association of breast arterial calcification and coronary heart disease. Obstet Gynecol. 2011; 117:233–241.

37. Abou-Hassan N, Tantisattamo E, D'Orsi ET, O'Neill WC. The clinical significance of medial arterial calcification in end-stage renal disease in women. Kidney Int. 2015; 87:195–199.

38. Hendriks EJE, Beulens JWJ, Mali WPTM, et al. Breast arterial calcifications and their association with incident cardiovascular disease and diabetes: the Prospect-EPIC cohort. J Am Coll Cardiol. 2015; 65:859–860.

39. Hendriks EJ, de Jong PA, van der Graaf Y, Mali WP, van der Schouw YT, Beulens JW. Breast arterial calcifications: a systematic review and meta-analysis of their determinants and their association with cardiovascular events. Atherosclerosis. 2015; 239:11–20.

40. Iribarren C, Molloi S. Breast arterial calcification: a new marker of cardiovascular risk? Curr Cardiovasc Risk Rep. 2013; 7:126–135.

41. Iribarren C, Sanchez G, Husson G, et al. MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease: cohort recruitment and baseline characteristics. Ann Epidemiol. 2018; 28:41–47.e12.