Background: Cardiovascular disease (CVD) is the second-leading cause of premature death in Canadian women and has a high cost burden on healthcare systems. However, the majority of women are unaware of their personal risk status. Breast arterial calcifications (BAC) are associated with an increased risk of CVD, incident CVD events, and correlate with other methods of cardiovascular risk stratification. BAC also positively correlate with multiparity, menopausal status, metabolic syndrome, hyperlipidemia, hypertension, diabetes, and chronic renal disease. The Canadian Society of Breast Imaging (CSBI) released their BAC reporting guidelines in January 2023, the first BAC guidelines published in North America. However, there are no other reporting guidelines or clinical management guidelines for BAC detected on mammography.
Learning Objectives: 1. Understand the association between BAC on mammography and cardiovascular risk. 2. Review the various methods to identify, quantify, and grade BAC including visual binary assessment, subjective severity grading, digital measurement and quantification, and artificial intelligence-based models. 3. Discuss the awareness and attitudes surrounding BAC of radiologists, referring physicians, and patients over the past 5 years. 4. Describe the current gaps, next steps, and challenges in implementation of BAC reporting and clinical management guidelines, including the necessity of interdisciplinary collaboration.
Abstract Content/Results: The purpose of this educational exhibit is to review the association of BAC and CVD, reporting methods, and the most recent perceptions of radiologists, referring physicians, and patients. Implementing a standardized BAC reporting model may allow for supplementary screening for CVD on screening and diagnostic mammography, leading to earlier identification of asymptomatic women at a high risk for adverse cardiac events and allowing for more targeted preventative care. Radiologist reporting of BAC is heterogeneous across Canada, Europe, and the United States of America. American survey studies suggest that referring physicians and patients prefer to be informed of the presence of BAC on mammography.
Conclusion: Given the overlap in populations of postmenopausal women and those undergoing screening mammography, there is opportunity to identify patients at risk for unsuspected CVD. Similar to standardized breast density notification, BAC reporting allows for autonomy and may empower patients to modify their lifestyle and other cardiovascular risk factors. The first reporting guidelines were published by the CSBI in January 2023. However, more work is needed to determine the optimal method of BAC grading and subsequent management recommendations.
