During their annual mammogram check-in, some patients may encounter an unexpected question: Would they like their mammogram evaluated for heart disease risk in addition to breast cancer? This is the experience of a colleague who visited Washington Radiology, which operates multiple locations in Washington, D.C., Maryland, and Virginia.
For $119, the practice offers an artificial intelligence (AI) analysis of mammograms to detect calcifications in breast arteries, which can indicate cardiovascular disease risk. Washington Radiology is among several facilities across the U.S. providing this service. While mammograms primarily serve to detect breast cancer, they can also reveal calcifications in breast arteries, visible as parallel white lines on the images. Although these calcifications are typically classified as incidental findings, they may correlate with heart disease risk.
Radiologists have noted these calcifications in reports for years, but this information often hasn’t reached patients. Now, some facilities are making this data accessible, sometimes for an additional fee.
In a promotional video, Islamiat Ego-Osuala, a radiologist at Washington Radiology, remarked on the potential of radiology, stating, “If the past few decades has taught us anything… the possibilities are endless.” However, some experts are skeptical about the value of screening for breast arterial calcification to assess heart disease risk.
Greg Sorensen, chief science officer at RadNet, which operates nearly 400 imaging centers, emphasized the distinction between calcification in breast arteries and that in coronary arteries. RadNet does not provide breast arterial calcification screenings, believing it lacks value. While RadNet offers AI analysis to enhance breast cancer detection, it does not extend to heart disease screening.
Coronary artery calcification is a well-known marker for heart disease risk. Studies suggest a link between breast arterial calcification and cardiovascular risk, yet uncertainties remain. For example, individuals without breast arterial calcification can still be at risk for heart disease or stroke. Research involving postmenopausal women found that while 26% had breast arterial calcification, many cardiovascular events occurred in those without it.
Sadiya Khan, a preventive cardiologist at Northwestern Medicine, expressed caution regarding breast arterial calcification as an indicator of heart disease risk, suggesting that while the area holds promise, more research is needed.
Given that heart disease is the leading cause of death for women in the U.S., responsible for over 300,000 deaths in 2021, clinicians are keen to utilize annual breast cancer screenings to also address heart disease risk. Many women remain unaware of their heart disease risk factors, such as high blood pressure, diabetes, and obesity.
Online risk calculators can help individuals evaluate their cardiovascular disease risk. For those with a 10-year risk of 7.5% or higher, lifestyle changes and medication may be recommended.
Laura Heacock, a breast imaging radiologist at NYU Langone Health, noted that much of the information from breast arterial scoring is already available from physicians. She emphasized that screenings can facilitate discussions about heart disease risk. A study indicated that 57% of women informed about their breast arterial calcification discussed their results with a healthcare provider.
At the Lynn Women’s Health and Wellness Institute in Boca Raton, Florida, every mammogram patient is screened for breast arterial calcification, a practice established in 2020. If calcifications are detected, patients are referred to a cardiologist for further evaluation. Heather Johnson, a preventive cardiologist at the center, acknowledged the need for additional research but highlighted that the screening creates an important communication channel. Notably, patients at this institute are not charged for the screening.
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