When people report for their annual mammogram these days, some may be faced with a surprising question: In addition to checking the mammogram for breast cancer, does the patient want the radiologist to review the images for the risk of heart disease?
That’s what happened recently when a colleague visited Washington Radiology, a practice with more than a dozen locations in Washington, DC, Maryland and Virginia.
For $119, she was told, the practice would use artificial intelligence software to analyze her mammogram for calcifications in the arteries of her breasts, which could indicate she is at risk for cardiovascular disease.
Washington Radiology is one of several practices across the country that offers this type of exam. Here’s what you should know about screening and whether research supports it.
Although breast x-rays are commonly used to detect and diagnose breast cancer, the images also show whether the arteries in the breast have calcifications, visible on the film as parallel white lines. Calcifications, considered “incidental” findings unrelated to breast cancer, may be linked to the risk of heart disease. They have been visible in images for decades and some radiologists have regularly noted them in their reports. But the information is not typically shared with patients.
Some practices now make the results available to patients – sometimes for a fee.
Washington Radiology did not respond to interview requests, but in a video on its website describing the practice’s “Mammo+Heart” AI screening, Islamiat Ego-Osuala, a breast imaging radiologist there, said, “If the last few decades have given us taught something.” Everything in the field of radiology is that the sky is the limit. The possibilities are endless.”
Some imaging experts question this rosy assessment as it relates to screening for mammary arteriosclerosis to estimate the risk of heart disease.
“What we see on the mammogram is calcification in the mammary artery, but that is not the same as calcification in the coronary artery,” said Greg Sorensen, chief scientific officer at RadNet, which has nearly 400 imaging centers in eight states. RadNet does not and does not offer screening for mammary arteriosclerosis. “It doesn’t feel like it’s adding value today,” Sorensen said.
(RadNet offers patients AI analysis of their mammograms to improve breast cancer detection. KFF Health News reported on it earlier this year.)
Calcification of the coronary arteries is considered a strong indicator of the risk of heart disease. But although studies have shown a connection between calcification of the mammary arteries and the risk of cardiovascular disease, questions remain.
On the one hand, even women who do not have breast arteriosclerosis may be at risk of heart disease, a heart attack, or a stroke. In a study of postmenopausal women, 26% had mammary artery calcification, and over a 6½-year study period, this was associated with a 23% increased risk of any type of heart disease and a 51% increased risk of heart attack or stroke. However, most cardiovascular events occurred in women who did not if you suffer from hardening of the thoracic arteries.
“I wouldn’t feel comfortable telling people that they have a higher or lower risk of heart disease because of the calcification of their chest arteries,” said Sadiya Khan, a preventative cardiologist at Northwestern Medicine in Chicago who is writing an editorial in a medical journal about it has study. “I think this is an exciting area, but we have to proceed cautiously.”
It’s understandable that gynecologists would like to embrace the idea of using the annual breast cancer screening that millions of women receive each year to also screen for the risk of heart disease.
Heart disease is the No. 1 cause of death in the United States. In 2021, it was responsible for more than 300,000 – or about one in five – deaths of women.
Many women are unaware of their risk of heart disease or the many factors that increase it, such as high blood pressure, diabetes, high cholesterol, smoking, drinking too much alcohol and being overweight.
Online calculators can help people estimate their risk of cardiovascular disease. For those whose 10-year risk is 7.5% or greater, doctors may recommend lifestyle changes and/or prescribe a statin to lower blood cholesterol levels. Laura Heacock, a radiologist specializing in breast imaging at NYU Langone Health in New York City, pointed out that patients can already get much of the information that comes from assessing mammary arteriosclerosis from their doctors and using these risk calculators. The key is that screening for mammary artery calcification provides another way to talk about the risk of heart disease.
One study found that 57% of women who were told they had calcification of the breast arteries after a mammogram said they discussed their results with their primary care doctor or a cardiologist.
Heacock said she would like to see more studies showing that reporting chest arteriosclerosis leads to changes in patient care and fewer heart attacks and strokes.
Every woman who visits the Lynn Women’s Health and Wellness Institute in Boca Raton, Florida, for a mammogram is screened for mammary arteriosclerosis. It has been a standard service since 2020, said Heather Johnson, preventive cardiologist at the center. If calcification is detected, the woman will be referred to a cardiologist or other doctor at the center to discuss the results and receive further information about the risk of heart disease.
Johnson acknowledged that more studies are needed to understand the connection between calcification in mammary arteries and heart disease. Still, she said, “screening allows for an avenue of communication.”
Boca Raton patients are not charged a fee for screening.
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