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Evaluation of Mammography Detected Breast Arterial Calcifications As a Predictor of Coronary Cardiac Risk Engy A

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Evaluation of Mammography Detected Breast Arterial Calcifications As a Predictor of Coronary Cardiac Risk Engy A Ali et al. Egyptian Journal of Radiology and Nuclear Medicine (2019) 50:81 Egyptian Journal of Radiology https://doi.org/10.1186/s43055-019-0095-7 and Nuclear Medicine RESEARCH Open Access Evaluation of mammography detected breast arterial calcifications as a predictor of coronary cardiac risk Engy A. Ali1,2* , Heba Fouad2, Naglaa A. Razek2, Ola M. Saeed2 and Sameh M. Helmy3 Abstract Background: Cardiovascular disease is one of the leading causes of death so detection of breast arterial calcifications on annually screening mammography can predict the possibility of future cardiovascular problems. Results: The 100 female patients were divided into two groups according to age: 1st group with age ranging from 40 to 60 years and 2nd group with age ranging from 61 to 80 years. There is increased percentage of cardiac cases among the BAC-positive patients in the 2nd group with a significant p value = 0.022 and this proved that there was a correlation between presence of BAC and being a cardiac case in the 2nd group, unlike the 1st group which showed no correlation. Conclusion: Incidental detection of breast arterial calcification in mammography in females above 60 years warrants further evaluation of their coronary atherosclerotic state and risk of future development of serious coronary artery disease. Keywords: Mammography, Breast arterial calcifications, Coronary artery disease Background Vascular calcification other than in coronary arteries has Cardiovascular disease was one of the leading causes of also been investigated [1]. mortality and morbidity in the world. One-third of Vascular calcifications which were seen via mammog- deaths were due to cardiovascular disease, causing health raphy were called Mönckeberg calcifications, and involve care costs and loss of productivity. Cardiovascular dis- the middle layer of the arteries. These calcifications were ease was the result of systemic arterial disease. Arterial totally diffuse and thin, and tend to take the entire cir- calcification was considered a marker of overall athero- cumference of the peripheral arteries, resulting in rigid sclerotic disease and therefore was a marker for future vessels with little capacity for distension [2]. Calcifica- cardiovascular events. Numerous studies had been done tions in patients less than 50 years old were infrequent to estimate coronary artery calcification noninvasively by and found in around 9.1% of mammograms. The preva- CT. The recent meta-analysis with asymptomatic pa- lence of calcifications for the female population ranged tients showed moderate increased risk (relative risk 2.1; from 9 to 17%, while in women aged 65 years and above, 95% confidence interval [CI], 1. 6–2.9) for cardiac the prevalence increased with age and exceeded 50% [3]. events. Aortic calcification identified at chest radiog- Cardiovascular disease and breast cancer were two of raphy tends to be independently related to coronary the main causes of mortality in women. Mammography heart disease (CHD), with an increased risk of 1.1 to 1.3. was recommended for all women from the age of 40 to 50 years as a screening test for breast cancer. Mammo- graphically detected breast arterial calcifications which * Correspondence: [email protected] discovered as incidentally finding were considered with- 1Radiology Department (Women’s Imaging Unit), Kasr El-Ainy Hospital ,Cairo out clinical importance, as they were not accompanied University, Cairo, Egypt by increased risk of breast cancer [4]. 2Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, El-Manial, Cairo 11956, Egypt However, the relation between breast arterial calcifica- Full list of author information is available at the end of the article tions on mammograms and the cardiovascular risk © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Ali et al. Egyptian Journal of Radiology and Nuclear Medicine (2019) 50:81 Page 2 of 8 factors as well as the atherosclerotic cardiovascular dis- High blood cholesterol—As blood cholesterol rised, ease had been shown in recent studies. The results of the risk of coronary heart disease increased. these studies suggested that breast arterial calcifications, High blood pressure—High blood pressure that which were detected during routine mammography, increased the heart’s workload could cause the heart could be valuable in identifying asymptomatic women at to thicken and become stiffer. increased cardiovascular risk [5]. Physical inactivity. Mönckeberg medial calcific sclerosis (MCS) was a Obesity and overweight—People who have exceed body ring-like calcification of small- to medium-sized vessels fat especially at the waist were likely to have heart without associated intimal thickening, appeared as “Rail- disease and stroke even if there was no other risk factors. road track” with classic radiographic linear pattern of Diabetes mellitus [9]. calcifications on mammography [6]. Methods Correlation between BAC and heart disease In our study, screening mammography was performed According to Saxena et al. 2005, the pathogenesis of in 100 women, whose ages ranged from 40 to 80 years MCS/BAC were related to several factors, including age- with the mean age 56.8 years, who had been examined related change, diabetes mellitus, chronic renal failure, with different cardiac investigations for the evaluation and coronary artery disease [6]. of coronary cardiac disease/risk. The presence of BAC, number of affected vessels, and the distribution Risk factors of calcification in the vessel wall were evaluated in the mammography. Subjects were questioned in terms of the cardiovascular risk factors including diabetes I. Vascular calcification of the breast: mellitus, hypertension, and dyslipidemia. The cardiac investigations included cardiac catheterization, CT coronary angiography, and thallium scan. Some studies had showed associations between vascular calcifications in breast tissue and chronic Inclusion criteria diseases such as diabetes, systemic arterial Our study included female patients with age ranging hypertension, coronary artery disease, kidney failure, from 40 to 80 years who had been examined with cardiac autonomic neuropathy, and hypervitaminosis D [7]. investigations (cardiac catheterization, CT coronary Arterial calcification in the breast could be associated angiography, or thallium scan) with either positive or with diabetes and hyperparathyroidism [8]. negative results for coronary cardiac disease/risk. Exclusion criteria II. Coronary calcification: Not present. Possible risk (a) The major risk factors that could not be changed: No possible risk. Methodology Increasing age—Over 83% of people who died of All patients were submitted to the following: coronary heart disease were 65 or older. Male sex (gender)—Men showed a greater risk of Full cardiac history (presence of risk factors and past heart attack than women do, which tended to occur history of cardiac ischemic insults) earlier in life. Cardiac investigations including one of the following Heredity (including Race)—Children of parents with cardiac catheterization (either diagnostic or heart disease were more likely to have heart diseases [9]. therapeutic), CT coronary angiography, or thallium scan. All the previous cardiac imaging were used to (b) The major risk factors you could modify, treat, or evaluate coronary artery calcifications, vascular control by changing your lifestyle or taking medicine: calcium deposition and scoring, atherosclerotic arterial changes and narrowing. Bilateral digital mammography as part of the annual Tobacco smoke—Smokers’ risk was 2–4 times of screening program was performed in mediolateral developing coronary heart disease than that of oblique and craniocaudal views using the digital nonsmokers. mammography system (Senographe 2000 D, GE). Ali et al. Egyptian Journal of Radiology and Nuclear Medicine (2019) 50:81 Page 3 of 8 The presence of BAC, number of affected vessels, groups, meaning there was no correlation between pres- and the distribution of calcification in the vessel wall ence of BAC and having risk factors in either age groups were evaluated in the mammography. (Tables 1, 2, 3, and 4). Correlation between the mammographic findings and the cardiac investigation results. Discussion Breast arterial calcifications which were detected during Results routine annual mammography screening were consid- Our study included 100 female patients with their age ered an incidental finding as they were not associated ranging from 40 to 80 years old, with the mean age 56.8 with increased risk of breast cancer. The goal of this re- years. They were subjected to cardiac investigations and search was to find a correlation between the presence of mammography with evaluation of risk factors from their BAC on mammography and cardiovascular disease and medical records. The results were as follows. their risk factors. Thus, BAC detected during routine So our study showed that there was increased percent- mammography could be valuable in identifying asymp- age of the BAC-positive cases among the 2nd group tomatic women at increased future CVD risk that may (54%) which was the group
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