A growing body of evidence has proved that cardiovascular disease clues lie in the breasts, with experts calling for more emphasis on the importance of mammography as a crucial screening tool for heart disease.
In the United States, an ongoing study is spotlighting the link between calcium deposits in the breast arteries and life-threatening heart risks – and saving lives in the process, reports NBC News.
Nancy Preston (67) didn’t have a heart attack. Nor did she have chest discomfort, shortness of breath or heart palpitations – all symptoms of heart disease. Instead, a routine mammogram led to her having quintuple bypass surgery a year ago.
“It was just something horrible waiting to happen,” she said. “I did not have symptoms, except for feeling a little more fatigued than usual, which I attributed to age.”
Preston does have a family history of heart disease. Her mother had a heart attack and a double bypass, and an older sister had a heart attack and has a pacemaker.
Even so, heart disease wasn’t top of mind for Preston, a yoga enthusiast who exercised daily and followed a healthy diet. Her high blood pressure and type 2 diabetes had been under control before her health scare, she said.
In October 2024, Preston got her annual mammogram at the Mount Sinai Health System in New York.
Doctors detected breast arterial calcifications, or BAC, on her mammogram: these are calcium build-ups within the breast arteries that may be associated with heart disease.
Currently, Mount Sinai is conducting a behavioural study to understand how women react to being notified about the arterial calcifications with their mammogram results.
After Preston, who is participating in the study, was notified of her breast arterial calcification, she underwent a cardiac stress test, which monitors the heart during physical exertion.
“Her heart function was very strong at rest, but during the stress portion, part of her heart muscle was not squeezing appropriately,” said Dr Mary Ann McLaughlin, a cardiologist at Mount Sinai Fuster Heart Hospital. “Her results indicated multi-vessel coronary artery disease.”
McLaughlin and Preston believe the BAC findings saved her life.
“The only reason that Nancy went ahead with a stress test was because she was a participant in the study,” McLaughlin said. “If she had come to me with what she had, which was well-controlled risk factors and no symptoms, I probably would not have referred her for the stress test.”
Preston continues to recover from the major surgery she had in July. “Thank God this BAC was shared with me,” she said.
Recommended
The US Preventive Services Task Force recommends women aged 40 to 74 get a mammogram every other year to screen for breast cancer. While federal law mandates that certain information, such as breast density, be included in mammography reports, providers don’t have to mention breast arterial calcifications.
Dr Laurie Margolies, chief of breast imaging at the Dubin Breast Centre at Mount Sinai and a leader of the study, hopes to change that.
“In more than 10% of mammograms, you will see calcified arteries, and people are always surprised,” said Margolies, who has been studying the relationship between breast arterial calcification and heart disease for about a decade.
“When the arteries are calcified in a breast, it makes logical sense that vessels might be calcified elsewhere.”
Breast arterial calcifications, which are specific to breast arteries, are different from the calcifications common to other areas of the breast. Macrocalcifications, which appear as white dots on a mammogram, are typically benign, according to the National Cancer Institute.
Microcalcifications appear as white specks and may indicate cancer in some cases. About half of women develop benign breast calcifications.
The Mount Sinai study, which began recruiting patients 40 and older in 2021, aims to analyse BAC rates in a diverse sample of 14 875 women. Margolies estimates 12.5% of women in the health system have breast arterial calcifications, including those with known heart conditions.
The second part of the study randomly splits 1 888 patients with breast arterial calcifications into two groups. Women in the first group are notified of their results, educated about heart disease risk and encouraged to consult a preventive cardiologist.
Women in the second group receive a standard mammography letter, then are notified of their BAC readings six months later.
Results are expected in early 2027.
How breast screening helps detect heart disease
A 2018 review published in the Journal of Cardiovascular Imaging advocated for mammography as a screening tool for heart disease. A 2022 study published in the journal Circulation: Cardiovascular Imaging, found an association between breast arterial calcification and heart disease in postmenopausal women aged 60 to 79, while 2024 research published in the journal JACC: Advances noted that BAC was “especially predictive” of heart disease in younger women aged 40 to 59.
Dr Naomi Ko, section chief of breast medical oncology at NYU Langone Health, said the Mount Sinai study adds to a growing body of evidence that cardiovascular disease clues lie in the breasts.
In some cases, women may be able to improve their heart health through behavioural and medication changes to stave off more serious medical intervention.
“Give me an opportunity to counsel my patients toward better lifestyle choices, and I’ll take it,” said Ko, who isn’t involved in the research. “If it triggers and influences improved health behaviour and engagement positively in your health care, awesome.”
The budding link between breast arterial calcification, also called vascular calcification, and heart disease is just that.
“It’s not a slam dunk,” Ko said. More research is needed, and women shouldn’t panic if they learn they have BAC.
“We know these calcifications are associated with cardiovascular challenges, but we’re not 100% certain about what that could mean for every single individual patient,” she said. “This is one data point about your body.”
Dr Steven Isakoff, co-clinical director of breast oncology at the Mass General Brigham Cancer Institute, and who wasn’t involved with the study, said educating healthcare providers is as big a hurdle as informing patients.
“Most of my colleagues, I would bet, are not aware of the association between breast arterial calcifications (and heart disease),” he said. “Without more specific guidance in the report about what steps to take, I would think it might not get acted upon.”
More research is needed to define how much arterial calcification in the breast may be cause for concern, he said, adding: “There’s a lot of information buried in mammograms.”
NBC News article – Can a mammogram help identify heart disease?
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