Mammography Helps Detect Heart Risk in Women!

Widely used mammography screening for breast cancer could potentially serve as a tool for detecting heart risk in women as well, a new study suggests.

Researchers said the study, involving 292 women, showed a strong correlation between the amount of calcium detected in breast arteries on a mammogram and the level of calcium in coronary arteries. Calcium in the arteries that nourish the heart is an important predictor of risk for heart attacks and strokes.

The findings of the study were presented at the American College of Cardiology’s 65th Annual Scientific Session and published March 24 in the journal Cardiovascular Imaging.

The new study identifies “an accessible way with no extra cost and no extra radiation [exposure] of determining someone’s risk for cardiovascular disease,” said Laurie Margolies, chief of breast imaging at Mount Sinai Medical Center, New York and lead author of the study.

Breast-artery calcium was at least as strong at predicting calcium in the coronary arteries as more traditional measures such as blood pressure, cholesterol and the widely used Framingham Risk Score, the study showed. “We hope this could be practice-changing,” Dr. Margolies said.

Some 37 million mammography exams are done in the U.S. each year, and often detect what doctors call “calcifications”—tiny spots of calcium that are generally benign, but can sometimes indicate breast cancer.

Mammography also picks up calcium in the breast arteries, which cardiologists have long considered potentially useful in assessing a woman’s heart risk.

While breast cancer takes the lives of approximately 40,450 women in the U.S. each year, according to the American Cancer Society, it’s not the top killer of women. Most women, it turns out, should be much more fearful of heart disease, since heart attack and stroke take the lives of more than 292,000 American women annually.

This new study showed that women with a high breast-artery calcium score—between four and 12—were more than three times as likely to have calcium in their coronary arteries as women who scored zero on the mammogram.

If such information were routinely included in a mammogram report, it could lead women to undergo further tests, including blood tests or heart scans to evaluate their heart risk. That could prompt such preventive strategies as changes in diet and exercise or use of cholesterol-lowering drugs called statins to reduce heart risk, Dr. Margolies said.

It is estimated that if 10% of women undergoing mammography tested positive for breast-artery calcium, nearly three million would turn out to have early signs of heart disease.

Bottom line: Mammography is now proven to have the additional benefit of screening for cardiovascular disease in women, without additional radiation or risk.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.


Dense Breasts: Ultrasound Beats 3D Mammography!

Ultrasound turned in a better incremental breast cancer detection rate than tomosynthesis in mammography-negative dense breasts, and a similar false-positive rate, according to interim findings from the ASTOUND trial.

During 2012-2015, the multicenter Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts (ASTOUND) trail screened 3,231 dense-breasted asymptomatic women (median age 51) with negative mammograms using both tomosynthesis and physician-performed ultrasonography.

Among more than 3,000 mammography-negative screening participants with dense breasts, 24 additional breast cancers (BC) were detected, of which 23 were invasive. All 23 were detected with ultrasound for an incremental cancer detection rate (CDR) of 7.1 per 1,000 screens (95% CI 4.2-10.0, P=0.006) versus 13 found with tomosynthesis (incremental CDR 4.0 per 1,000 screens, 95% CI 1.8-6.2), reported Nehmat Houssami, MBBS, MPH, PhD, of the University of Sydney, and colleagues. This study was recently published in the Journal of Clinical Oncology and presented at the 1oth European Breast Cancer Conference.

“Our results could be taken to suggest that tomosynthesis is detecting [breast cancers] that would have been otherwise masked (on 2D mammography) by overlapping breast parenchyma, but seems less capable than ultrasound at finding cancers that are entirely masked by mammography-dense tissue,” Houssami’s group wrote. “We assume that some cancers are visible to only one of the physical principles of imaging modalities (x-ray for tomosynthesis vs ultrasound).”

The majority of ultrasound-detected cancers undetected by tomosynthesis were masses, whereas the single malignancy detected by tomosynthesis but missed by ultrasound was an architectural distortion.

The authors pointed out that these results are interim only, and relate to a self-referring population of women with dense breasts and negative mammograms.

One of the historical barriers to implementing ultrasound (US) breast cancer screening in practice has been the high rate of false-positives, explained Wendie Berg, MD, PhD, of Magee-Womens Hospital of University of Pittsburgh Medical Center, in an accompanying editorial.

“Importantly, in preliminary results from the ASTOUND trial, false-positive recalls (2.0%) and biopsies (0.7%) were acceptably low,” she noted.

However, she pointed out that “these low rates likely reflect that most of the US screens in ASTOUND were incident screens (with prior examinations available); further, recommendations for short interval follow up (Breast Imaging-Reporting and Data System density categories three) were not considered test positive.”

But Berg suggested that the two modalities can work together. “On the basis of the results from ASTOUND, tomosynthesis still misses a substantial number of invasive cancers in women with dense breasts: supplemental US after tomosynthesis would still be reasonable, although further study is warranted,” she wrote.

Bottom line: The combination of 3D tomosynthesis mammography and whole breast ultrasound significantly improves breast cancer detection in women with “dense” breasts.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.