Background: Breast imaging plays a critical role in the diagnosis and early detection of breast cancer, but there is more to learn from these images. Breast arterial calcifications (BAC) are common findings on screening mammograms and have been shown to be correlated with coronary artery calcifications and serve as a sex-specific cardiovascular disease biomarker. However, there is no agreed-upon BAC grading system or standardized reporting system. In this exhibit, we will review the pathophysiology of breast arterial calcifications, summarize evidence on their role in cardiovascular risk assessment, and review proposed methods of grading and reporting using mammography examples.
Learning Objectives: 1. Review the vascular supply of the breast and the pathophysiology of intimal versus medial calcifications 2. Provide background on how breast calcifications correlate to cardiovascular risk and current perceptions of breast arterial calcifications by breast imagers 3. Review different proposed methods of grading breast arterial calcifications on mammography 4. Provide imaging examples of various grades of breast arterial calcifications
Abstract Content/Results: ● Arterial supply of the breast ● Pathophysiology of BAC ○ Intimal calcification ○ Medial calcification ○ Comparison and clinical outcomes ● Clinical importance ○ Cardiovascular disease is a leading cause of death in asymptomatic women ○ Breast arterial calcifications are a known independent cardiovascular risk factor ○ Surveys of patients showed a strong preference to be informed of breast arterial calcifications and to seek treatment if necessary ● Current attitudes towards reporting arterial calcifications in breast imaging ○ Review of survey results for Europe, Canada, and the United States on attitudes regarding breast arterial calcifications ● Reporting systems with imaging examples ○ General subjective assessment of BAC - mild, moderate, severe ○ 12-point breast arterial calcification score ○ BAC semiquantitative score ○ Canadian Society of Breast Imaging (CSBI) proposed grading system ● Future directions ○ Standardization of language and grading ○ Automation of BAC detection with AI ○ Provider education and advocacy for implementation of reporting and clinical follow-up
Conclusion: Mammography provides additional information about the risk of cardiovascular disease, which is the leading cause of death in women worldwide. Opportunistic use of such imaging biomarkers will expand the clinical use of mammography beyond cancer detection and play a role in improving the health of women. This review will help increase awareness of BAC correlation with cardiovascular risk and provide education regarding existing grading and reporting systems and guidelines.
