Arterial Calcification on Mammogram: Clinical Significance
Arterial calcification detected on mammography represents calcification of breast arteries and is classified as a benign finding (BI-RADS Category 2) with no association to breast cancer risk, but it serves as an important cardiovascular risk marker that warrants clinical attention and potential cardiology referral. 1
What It Represents
Breast arterial calcification (BAC) appears as linear, parallel tracks along the course of breast arteries on mammography, distinct from suspicious microcalcifications associated with malignancy. 1
BAC involves medial arterial calcium deposits leading to arterial stiffening, which differs pathophysiologically from coronary artery calcification (CAC) that represents intimal deposits. 1
BAC is more closely related to diabetes and hypertension than to traditional atherosclerotic risk factors like smoking and hyperlipidemia. 1
Cardiovascular Disease Association
Women with BAC have a 51% increased hazard of atherosclerotic cardiovascular disease (ASCVD) over 6.5 years of follow-up (HR 1.51,95% CI 1.08-2.11). 1
BAC is strongly associated with prevalent cardiovascular disease events with an odds ratio of 2.29 (95% CI 1.40-3.74), even after accounting for age and other traditional risk factors. 2
BAC predicts significant coronary artery disease on coronary CT angiography in symptomatic women and correlates with higher Gensini scores for coronary disease severity. 3, 4
The presence of BAC provides additional risk stratification beyond the pooled cohort equation, with a net reclassification improvement of 0.12 (P=0.01). 1
Clinical Management Implications
BAC should be considered a risk-enhancing factor for ASCVD among women undergoing mammography, according to the American Heart Association. 1
Women with BAC who fall into borderline or intermediate ASCVD risk categories may require more aggressive cardiovascular prevention treatment. 1
Women with BAC who are already at high cardiovascular risk may need therapy intensification. 1
Consider cardiology referral for cardiovascular risk assessment and potential initiation or optimization of cardio-protective medications when BAC is present. 4, 5
Associated Risk Factors
BAC prevalence increases significantly with age and duration of menopause. 3, 2
Five cardiovascular risk factors are significantly more prevalent in BAC-positive women: age, hypertension, hypercholesterolemia, diabetes mellitus, and menopause status. 2
BAC occurs in approximately 14-39% of women undergoing screening mammography, with higher rates in older populations. 1, 2
Reporting Considerations
While professional society guidelines on mandatory BAC reporting have not yet been established, documenting BAC in mammography reports may facilitate earlier cardiovascular risk mitigation in asymptomatic women. 5
BAC should be mentioned in mammography reports as it may be important in warning clinicians about potential coronary artery disease. 3
Critical Distinction from Malignant Calcifications
BAC has no association with increased breast cancer risk and should not be confused with suspicious microcalcifications. 6, 5
Malignant calcifications appear as fine pleomorphic or fine-linear branching patterns in clustered, segmental, or ductal distributions (BI-RADS 4-5), whereas BAC appears as linear parallel tracks along vessel walls (BI-RADS 2). 1, 7