:::: FOR OUR REFERRING PHYSICIANS : NEWSLETTER :.

Arterial Calcifications

Dear Colleagues:

Arterial calcifications are regarded as part of the normal aging process. They are commonly identified on mammographic studies and are usually regarded as incidental findings, and unless they are unusually prominent, are rarely mentioned in the mammographic report.

Premature atherosclerosis may be a harbinger of a clinically unsuspected systemic condition that requires appropriate medical management. For this reason, we feel a responsibility to draw attention to atherosclerotic findings noted on mammography in women under the age of 60. I hope you will find the enclosed commentary on the subject useful.

Should you have any questions or comments pertaining to this subject or other breast-related concerns, please feel free to call me or my associates Dr. Paul Meunier or Dr. Jane Bedell.

Sincerely,

G.W. Eklund, M.D., FACR

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Calcified arteries seen mammographically:
Do they have any clinical significance?

G.W. Eklund, M.D., FACR
Medical Director, Pacific Breast Center

Mammographically detected breast arterial calcifications (BAC) increase in frequency with advancing age, especially after menopause. Unless they are unusually prominent, BAC are regarded as an incidental finding and seldom mentioned in the mammographic report. In spite of numerous articles pertaining to the association of BAC with coronary artery disease, diabetes, hypertension, hypercholesterolemia and other conditions associated with atherosclerosis, considerable controversy remains about the predictive value of BAC for other conditions associated with atherosclerosis. In an article appearing in the May 2004 Journal of Women's Health, "Breast Vascular Calcification and Risk of Coronary Heart Disease, Stroke and Heart Failure," researchers at the Kaiser Permanente Northern California Division of Research found a modest but significant association between breast vascular calcification and risk of coronary heart disease, stroke and heart failure.

From our own experience, and from a review of the literature, we believe it is important to recognize clinically unsuspected premature atherosclerosis. In our mammographic reporting, we have adopted the policy of mentioning the presence of BAC in patients under 60 years of age. If the clinician is already aware of systemic disease, such as diabetes, renal disease, coronary artery disease, hypercholesterolemia, etc. that would explain atherosclerotic changes, the presence of BAC would be an incidental finding. On the other hand, BAC in women under age 60, with no known reason to have atherosclerosis, should be evaluated for an underlying disorder to explain premature atherosclerosis and which may require medical management.

Identifying BAC may provide an incentive toward a heart-healthy diet, stopping smoking or getting into an exercise program.

References:

1. Moshyedi AC, Puthawala AH, Kurland RJ, O'Leary DH. Breast arterial calcification: association with coronary artery disease. Radiology 1995; 194:181-183.
2. Sommer G, Kopssa H, Zazgornil J, Salomonowitz E. Breast calcification in renal hyperparathyroidism. AJR 1987; 148:855-857.
3. Cetin M, Cetin R, Tamer N, Kelekci S. Breast arterial calcifications associated with diabetes and hypertension. J Diabetes Complications. 2004;18(6):363-6.
4. van Noord PA, Beijerinck D, Kemmeren JM, van der Graaf Y. Mammograms may convey more than breast cancer risk: breast arterial calcification and arterio-sclerotic related diseases in women of the DOM cohort. Eur J Cancer Prev. 1996; 5(6):483-7.
5. Markopoulos C, Mantas D, Revenas K, Kouskos E, Tzonou A, Liapis C, Kostakis A. Breast arterial calcifications as an indicator of systemic vascular disease. Acta Radiol. 2004; 45(7):726-9.