Your annual screening mammogram may do more than spot breast cancer early — it may give you a heads up on your heart disease risk, too. For Black women, a heads up is crucial. According to the American Heart Association, cardiovascular diseases kill nearly 50,000 Black women annually.
Digital breast X-rays can also detect a build-up of calcium in the arteries of your breasts, an early sign of heart disease. These white areas — known as breast arterial calcification, or BAC — are markers of hardening in the arteries and tend to go along with advancing age, type 2 diabetes, high blood pressure and inflammation. (It is not the same as calcification of the inner layer of the arteries that is often found in smokers or people with high cholesterol.)
“A single test that is universally accepted can address the two leading causes of death in women,” says study author Dr. Carlos Iribarren. He is a research scientist at the Kaiser Permanente Northern California Division of Research, in Oakland.
For the study, his team reviewed health records of more than 5,000 women, aged 60 to 79, who underwent one or more screening mammograms. None of these women had a history of heart disease or breast cancer when the study began. They were followed for about 6.5 years.
Those whose mammogram showed breast arterial calcifications were 51% more likely to develop heart disease or have a stroke compared with women without calcium build-up in their arteries, the study found.
In addition, women with calcium build-up were 23% more likely to develop any type of heart or vascular disorder, including heart disease, stroke, heart failure and related diseases, the study shows.
“BAC provides additional information and is not intended to replace any current risk factors for heart disease,” Iribarren says.
Counseling should be done in the context of a woman’s overall heart disease risk, he notes.
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“For women with low risk, BAC presence should be a trigger of adhering to healthy lifestyles including a heart-healthy diet, avoiding smoking and exercising regularly,” he advises. “For women with intermediate-risk, BAC should also prompt a discussion with the doctor about initiating treatment for risk factors such as cholesterol, blood pressure and diabetes that are not well controlled by lifestyle alone.”
Although reporting of BAC levels is not mandatory, radiologists should include this information in their report, Iribarren shares.
“A relatively small proportion already do, but more importantly, there is research showing that women overwhelmingly want this information provided to them and their primary care doctors,” he says.
Because this information can be obtained during a routine screening mammogram, there would be no extra cost or radiation exposure.
The findings were published March 15 in the journal Circulation: Cardiovascular Imaging.
Dr. Natalie Avella Cameron, an instructor at Northwestern University’s Feinberg School of Medicine in Chicago, co-wrote an editorial that accompanied the findings.
“If future research shows that BAC improves heart disease risk prediction among women not yet on cholesterol-lowering medications, BAC could serve as a powerful tool to help guide heart disease prevention for the millions of women who undergo routine mammography each year,” she says.
But, Cameron notes, women without calcium build-up on their breast arteries can still develop heart disease.
“We should be assessing heart disease risk factors such as obesity, high blood pressure, high cholesterol and diabetes, and discussing how to optimize heart health through lifestyle changes such as eating a plant-based diet and staying active, regardless of BAC status,” she adds.
Knowledge of BAC status could be powerful and potentially life-saving information, says cardiologist Dr. Nieca Goldberg, who reviewed the findings. She’s medical director at Atria New York City and a clinical associate professor of medicine at New York University.
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“Heart disease is the No. 1 killer of women, yet many women are more worried about breast cancer,” Goldberg shares. “Women’s health issues are not siloed. A test for breast cancer can give us clues to heart disease risk, too.” According to the American Heart Association, only 36% of African American women know that heart disease is their greatest health risk.
Calcium build-up in arteries is an early sign of heart disease risk, she says.
“We don’t know how any intervention would change calcifications, but exercising, quitting smoking, getting diabetes under control, eating a healthier diet, and managing cholesterol and blood pressure can help lower risk for heart attack,” Goldberg concludes.
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