Mammograms May Offer Clues to Heart Disease Risk, But Reporting Varies

Mammograms, primarily used for breast cancer screening, may also provide valuable insights into a woman's risk for heart disease, the leading cause of death for women in the U.S. However, current practices often overlook this secondary information, with only Maryland requiring radiologists to inform patients about findings like breast arterial calcification (BAC).

BAC occurs when calcium deposits build up in the arterial walls of the breast. While historically considered an incidental finding, recent studies suggest a correlation between BAC and an increased likelihood of future cardiovascular events. A 2022 study found that women with visible BAC on their mammograms were 51% more likely to develop heart disease or experience a stroke compared to those without it. Another study in April involving over 21,000 women indicated that a higher degree of BAC, relative to a woman's age, correlated with an increased risk of developing cardiovascular disease within approximately 4.7 years.

Researchers emphasize that the presence of BAC does not signify existing heart disease but rather serves as a potential indicator of future risk. Matthew Nudy, an assistant professor at Penn State College of Medicine, noted in a press release that existing cardiovascular risk assessment tools may underestimate risk in women. He suggested that assessing BAC could lead to improved risk prediction and prevention strategies.

In response to growing evidence, Maryland became the first state to mandate that radiologists notify patients of BAC findings on mammograms at no additional cost, effective October 1. Tahira Ahmed, a breast radiologist and medical director for the Maryland imaging network of RadNet, expressed optimism that other states would follow suit.

Despite support from some medical societies, the Maryland law has faced some opposition. A group of Johns Hopkins breast radiologists argued that the mandate is premature due to the lack of a standardized clinical pathway for managing BAC findings. They also raised concerns that it could distract from the primary goal of breast cancer detection and potentially cause unnecessary anxiety or testing.

Proponents, however, argue that patients have a right to this information. Dr. Nina Vincoff, chief of breast imaging at Northwell Health, stated that women would prefer to be informed and take preventive action rather than be shielded from potentially serious health warnings. Cardiovascular disease accounts for approximately one in three deaths among women annually in the U.S., a figure higher than all forms of cancer combined. Despite this, fewer than half of women recognize heart disease as their primary health threat, according to the American Heart Association. Cardiovascular disease affects nearly 45% of women aged 20 and older.