When people get their annual mammograms today, some may be faced with a surprising question: In addition to checking mammograms for breast cancer, do you want a radiologist to check your risk of heart disease?
That happened recently when a colleague visited Washington Radiology, a practice with more than a dozen locations in Washington, DC, Maryland, and Virginia.
For $119, she was told, the practice would use artificial intelligence software to analyze mammograms for calcifications in the breast arteries, which could indicate she is at risk for cardiovascular disease.
Washington Radiology is one of the few practices nationwide that offers this type of screening. Here’s what you need to know about screening and whether research supports it.
Although breast X-rays are usually used to detect and diagnose breast cancer, these images also show that the arteries in the breast have calcifications, which appear as parallel white lines on the film. Calcifications, considered an “incidental” finding unrelated to breast cancer, may be linked to a person’s risk of heart disease.
They have appeared on images for decades, and some radiologists have noted them regularly in their reports. But that information is usually not passed on to patients.
Now some practices make the results available to patients — sometimes for a fee.
Washington Radiology did not respond to requests for an interview, but in a video on its website describing the practice’s “Mammo + Heart” AI screening, Islamiat Ego-Osuala, a breast imaging radiologist there, said, “If the past few decades have taught us anything. in the field of radiology, the sky’s the limit. The possibilities are endless.”
Some imaging experts question the rosy assessment as it relates to breast artery calcification screening to measure heart disease risk.
“What we see on a mammogram is calcification in the breast artery, but it’s not the same as calcification in the coronary artery,” said Greg Sorensen, chief science officer at RadNet, which has nearly 400 imaging centers in eight states. RadNet does not offer breast artery calcification screening and does not plan to. “You don’t feel like it’s worth it today,” Sorensen said.
(RadNet offers patients AI analysis of mammograms to improve breast cancer detection. KFF Health News reported earlier this year.)
Coronary artery calcification is recognized as a strong marker of heart disease risk. But while studies have shown a link between breast artery calcification, or BAC, and cardiovascular disease risk, questions remain.
For one thing, even if you don’t have breast artery calcification, you may be at risk for heart disease, heart attack, or stroke. In a study of postmenopausal women, 26% had breast artery calcification, and over the 6½-year study period it was associated with a 23% increased risk of any heart disease and a 51% increased risk of heart attack or stroke. However, most cardiovascular events occur in women who do not have breast artery calcification.
“I don’t like to tell people that they have a higher or lower risk of heart disease based on breast artery calcification,” said Sadiya Khan, a preventive cardiologist at Northwestern Medicine in Chicago who wrote a medical journal editorial commenting on the study. “I think it’s an exciting area, but we have to be careful.”
It’s understandable that women’s health doctors are eager to implement the idea of ​​using the annual breast cancer screening that millions of women also undergo each year to check for heart disease risk.
Heart disease is the number 1 killer in the United States. It is responsible for more than 300,000 – or about 1 in 5 – female deaths by 2021.
Many women are unaware of their risk of heart disease or the many factors that increase it, such as high blood pressure, diabetes, high cholesterol, smoking, drinking too much alcohol, and being overweight.
There are online calculators that can help people determine their risk of cardiovascular disease. For those with a 10-year risk of 7.5% or more, doctors may recommend lifestyle changes and/or prescribe statins to lower blood cholesterol.
Laura Heacock, a radiologist who specializes in breast imaging at NYU Langone Health in New York City, points out that patients can get a lot of information from breast artery scores from their doctors and use risk calculators. The key is that screening provides another opportunity to talk about heart disease risk.
One study found that 57% of women who reported having breast artery calcification after a mammogram reported they had discussed the results with their primary care physician or cardiologist.
Heacock said he would like to see more studies showing that BAC reporting leads to changes in patient care and fewer heart attacks and strokes.
Every woman who visits the Lynn Women’s Health and Wellness Institute in Boca Raton, Florida, for a mammogram is screened for breast artery calcification. That’s a standard service starting in 2020, said Heather Johnson, a preventive cardiologist at the center. If calcifications are found, the woman is referred to a cardiologist or other health practitioner at the center to discuss the findings and obtain more information about her risk of heart disease.
Johnson acknowledged that more research is needed to understand the link between calcification in the breast arteries and heart disease. Instead, he said, the filter “allows a line of communication.”
Patients at the Boca Raton facility are not charged for the screening.
Jackie Fortiér reports the audio story.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs at KFF.