Mammographically detectable breast arterial calcification and atherosclerosis

Abstract

Breast arterial calcification (BAC), observed as an incidental finding on screening mammograms, represents degenerative calcific changes occurring in the mammary arteries, with increasing age. The aim of this review is to discuss relevant literature examining relation between BAC and atherosclerosis. After a thorough literature search, in OVID and PubMed, 199 studies were identified, of which 25 were relevant to our review. Data were abstracted from each study and statistical analysis was done, including calculation of odds ratios and construction of forest plots. A total of 35,542 patients were enrolled across 25 studies looking at an association between BAC and coronary artery disease, cardiovascular disease, stroke, cerebral artery disease, carotid and peripheral artery diseases, and coronary artery calcification. A majority of the studies showed a statistically significant relation between BAC and presence of coronary artery disease cardiovascular disease and associated mortality. Sensitivity of BAC in predicting cardiovascular events was low, but specificity was high. BAC was predictive of incident and prevalent stroke but not mortality of stroke. Similarly, BAC was predictive of cerebral, carotid, and peripheral artery diseases. The role of BAC as a surrogate marker of coronary and systemic atherosclerosis is currently uncertain. Its role may be further elucidated by more large-scale prospective studies and clinical experience.

FIGURE 1

Screening mammogram showing breast arterial calcification. The length of breast arterial calcification is defined as longest continuous calcified segment, which is C to D in the depicted vessel A to B (Reproduced with permission from Zgheib et al).

FIGURE 2

Figure showing crude and adjusted odds ratios (OR) with 95% confidence intervals of case-control studies examining the relation between breast arterial calcification and angiographic coronary artery disease (CAD). *Obstructive CAD (≥50% stenosis) considered as endpoint and ** self-reported CAD used with breast arterial calcification positive considered as case.

FIGURE 3

Figure showing crude and adjusted prevalence odds ratios (ORs)/hazards ratios with 95% confidence intervals of cross-sectional studies examining the relation between breast arterial calcification and coronary artery disease, cardiovascular disease (CVD) and cardiovascular mortality. *Atherosclerotic CVD defined as self-reported angina, history of myocardial infarction or coronary artery bypass graft, or abnormal coronary angiogram or stroke; **cardiovascular mortality; ***CVD defined as coronary artery disease or history of myocardial infarction or stroke or congestive heart failure; and ****prevalent myocardial infarction, used as endpoint.

FIGURE 4

Figure showing crude and adjusted incidence odds ratios (ORs)/hazards ratios with 95% confidence intervals of prospective and retrospective cohort studies examining the relation between breast arterial calcification and coronary artery disease, cardiovascular disease, and cardiovascular mortality. **Cardiovascular mortality used as endpoint.

FIGURE 5

Figure showing crude and adjusted odds ratios (OR)/hazards ratios with 95% confidence intervals of studies examining the relation between breast arterial calcification and stroke and stroke mortality. *Mortality from stroke used as endpoint.