Prevalence and Severity of Breast Arterial Calcification on Routine Mammography

Aim. To determine the frequency of detection and severity of breast arterial calcification (BAC) among women undergoing mammography on the basis of medical institutions in Moscow.
Material and methods. The analysis included 4274 digital mammograms of women aged 40-93 who underwent preventive or diagnostic mammography. Standard full-format digital mammograms were performed in craniocaudal and mediolateral oblique projections. In addition to the standard diagnosis of breast disease, all mammograms were evaluated for the presence of BAC. The severity of BAC was assessed on a 12-point scale: mild 3-4 points, moderate 5-6 points, severe 7-12 points.
Results. The average frequency of BAC was 10.1%, in the middle age group 50-59 years – 6.0%. The incidence of BAC increased with age, from 0.4% to 0.6% in women <50 years of age to >50% in women ≥80 years of age. A statistically significant and pronounced correlation was found between the woman's age and the presence of BAC r Pearson =0.769 (p<0.001). There was also a less noticeable but statistically significant correlation between age and severity of BAC r Spearman =0.319 (p<0.001). Regression analysis made it possible to estimate the probability of CAD depending on age. In women <50 years of age, only mild to moderate calcification occurred, while those ≥65 years of age had a significant increase in the incidence of severe CAD.
Conclusion. There was an expected increase with age in both prevalence and severity of BAC. Cases of severe BAC in women younger than 65 years of age and any BAC in women younger than 50 years of age are atypical and require clarification of their association with cardiovascular and other diseases.

1. Bochkareva EV, Kim IV, Butina EK, et al. Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 2. Association of Breast Arterial Calcification and Cardiovascular Diseases. Rational Pharmacotherapy in Cardiology 2019;15(3):424-30 (In Russ.). DOI:10.20996/1819-6446-2019-15-3-424-430.

2. Polonsky TS, Greenland P. Breast Arterial Calcification Expanding the Reach of Cardiovascular Prevention. Circulation. 2017;135(6):499-501. DOI:10.1161/CIRCULATIONAHA.116.025277.

3. Suh JW, Yun B. Breast Arterial Calcification: A Potential Surrogate Marker for Cardiovascular Disease. Cardiovasc Imaging. 2018;26(3):125-34. DOI:10.4250/jcvi.2018.26.e20.

4. Hendriks EJE, de Jong PA, van der Graaf Y, et al. Breast arterial calcifications: A systematic review and meta-analysis of their determinants and their association with cardiovascular events. Atherosclerosis. 2015;239(1):11-20. DOI:10.1016/j.atherosclerosis.2014.12.035.

5. Yoon YE, Kim KM, Lee W, et al. Breast arterial calcification is associated with the progression of coronary atherosclerosis in asymptomatic women: A preliminary retrospective cohort study. Scientific Reports. 2020;10(1):2755. DOI:10.1038/s41598-020-59606-y.

6. Iribarren C, Sanchez G, Husson G, et al. MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease: cohort recruitment and baseline characteristics. Ann Epidemiol. 2018;28(1):41-47.e12. DOI:10.1016/j.annepidem.2017.11.007.

7. Lee SC, Phillips M, Bellinge J, et al. Is breast arterial calcification associated with coronary artery disease? — A systematic review and meta-analysis. PLoS One. 2020;15(7):e0236598. DOI:10.1371/journal.pone.0236598.

8. Bochkareva EV, Butina EK, Bayramkulova NKh, et al. Assessment of the Severity of Breast Artery Calcification on a Mammogram: Intraoperator and Interoperator Reproducibility. Rational Pharmacotherapy in Cardiology. 2021;17(5):688-95 (In Russ.) DOI:10.20996/1819-6446-2021-10-07.

9. Kemmeren M, van Noord PAH, Beijerinck D, et al. Arterial calcification found on breast cancer screening mammograms and cardiovascular mortality in women the DOM Project. Am J Epidemiol. 1998;147(4):333-41. DOI:10.1093/oxfordjournals.aje.a009455.

10. Iribarren C, Go AS, Tolstykh I, et al. Breast vascular calcification and risk of coronary heart disease, stroke and heart failure. J Womens Health (Larchmt). 2004;13(4):381-9. DOI:10.1089/154099904323087060.

11. Rotter MA, Schnatz PF, Currier AA Jr, O’Sullivan DM. Breast arterial calcifications (BACs) found on screening mammography and their association with cardiovascular disease. Menopause. 2008;15(2):276-81. DOI:10.1097/gme.0b013e3181405d0a.

12. Schnatz PF, Marakovits KA, O'Sullivan DM. The association of breast arterial calcification and coronary heart disease. Obstet Gynecol. 2011;117(2 Pt 1):233-41. DOI:10.1097/AOG.0b013e318206c8cb.

13. Hendriks EJE, Beulens JWJ, Mali WPTM, et al. Breast arterial calcifications and their association with incident cardiovascular disease and diabetes: the Prospect-EPIC cohort. J Am Coll Cardiol. 2015;65(8):859-60. DOI:10.1016/j.jacc.2014.12.015.

14. Loberant N, Salamon V, Carmi N, Chernihovsky A. Prevalence and Degree of Breast Arterial Calcifications on Mammography: A Cross-sectional Analysis. J Clin Imaging Sci. 2013;3:36. DOI:10.4103/2156-7514.119013.

15. Yoon YE, Kim KM, Han JS, et al. Prediction of Subclinical Coronary Artery Disease with Breast Arterial Calcification and Low Bone Mass in Asymptomatic Women Registry for the Women Health Cohort for the BBC Study. JACC Cardiovasc Imaging. 2019;12(7Pt1):1202-11. DOI:10.1016/j.jcmg.2018.07.004.

16. Abouzeid C, Bhatt D, Amin N. The Top Five Women’s Health Issues in Preventive Cardiology. Curr Cardiovasc Risk Rep. 2018;12:6. DOI:10.1007/s12170-018-0568-7.

17. Wilmot KA, O’Flaherty M, Capewell S, et al. Coronary heart disease mortality declines in the United States from 1979 through 2011: evidence for stagnation in young adults, especially women. Circulation. 2015;132(11):997-1002. DOI:10.1161/CIRCULATIONAHA.115.015293.

18. Drapkina OM, Kontsevaya AV, Kalinina AM, et al. 2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines. Cardiovascular Therapy and Prevention. 2022;21(4):3235 (In Russ.) DOI:10.15829/1728-8800-2022-3235