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Can mammograms show who is at risk of heart failure?

Mammograms have, so far, had the single role of identifying potentially cancerous tumors in the breast. However, could they also help doctors identify women at risk of heart disease and heart failure?

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Some researchers believe that mammograms could also help doctors identify women with a high risk of heart failure.

Mammograms work by using low energy X-rays to “scan” breast tissue for irregularities and abnormalities that may be signs of cancer. They are the first port of call when it comes to diagnosing breast cancer in its early stages.

In 2016, the United States Preventive Services Task Force recommended that women aged 50–74 years — the age range in which women’s risk of breast cancer increases — should undergo breast cancer screening once every 2 years.

Mammograms do not only detect potential cancerous tumors, though. As it turns out, they also show the formation of breast arterial calcifications, which are calcium buildups inside the arteries in the breast.

This, at least, is the finding of recent research by Dr. Quan Minh Bui and colleagues from the University of California, San Diego. Dr. Bui and team presented their findings at this year’s American Heart Association’s Scientific Sessions, which took place in Philadelphia, PA, last month.

Killing two birds with one stone?

Breast arterial calcification is often associated with coronary artery calcium — a dangerous buildup of calcium sediment in the arteries that transport oxygenated blood to the heart — particularly in women.

Coronary artery calcium is, in itself, a strong predictor of cardiovascular disease, and doctors will use computed tomography (CT) scans to screen for these buildups in people whom they believe to be at risk.

Dr. Bui and colleagues argue that breast arterial calcification can help identify women who may be at risk of cardiovascular problems, including heart attack, stroke, and heart failure, in which the heart is unable to pump blood effectively.

In particular, the investigators argue that mammograms — which women over a certain age will often undertake as a regular screening procedure anyway — could help doctors detect not just cancer but also the risk of heart disease. They explain that these tests could do this by highlighting the presence of calcium buildups in breast arteries.

Mammography has the potential to alter the course of two leading causes of death in women: breast cancer and heart disease.”

Dr. Quan Minh Bui

“We believe that there is truth to the sentiment that ‘a picture is worth a thousand words,’ and that seeing calcifications in the breast arteries may empower patients to participate in their medical care,” he adds.

Looking at the evidence

In their study, the investigators analyzed data from the medical records of 278 female participants with a mean age of about 61 years. These records covered the period of 2006–2016.

All of these participants had undergone both a mammogram and a coronary CT scan within the same year.

The researchers observed that as many as 90 participants (32%) had breast arterial calcification, while 19 of them (7%) had heart failure.

After they adjusted their analysis for confounding factors — including age, diabetes, high blood pressure, and risk factors for heart failure — the investigators found that female participants with breast arterial calcification had 2.2 times the likelihood of either having or developing heart failure, compared with those without calcium buildups.

Heart failure in women is challenging for doctors to diagnose and treat because it has slightly different causes than heart failure in men, and it develops in different ways.

Women typically develop heart failure later in life than men, and they also tend to experience more clinical symptoms. Compared with men, women with heart failure have stiffer heart muscles but maintain a normal blood pumping ability.

“That’s why preventing heart failure from developing in the first place is so important, by identifying at-risk individuals and applying appropriate lifestyle and pharmacology strategies,” explains Dr. Erin Michos, director of women’s cardiovascular health at Johns Hopkins School of Medicine in Baltimore, MD, who did not contribute to the current study.

If mammograms could reveal the presence of markers of heart failure risks, this may help doctors address this issue earlier on. However, Dr. Michos cautions, it remains unclear what course of action doctors should take in this case.

At present, Dr. Bui and colleagues are taking their recent research further by analyzing an additional set of mammograms from female participants who have also received a diagnosis of cardiovascular conditions relating to calcium buildup in the arteries.

In the meantime, the researchers advise healthcare professionals to start including more information about heart health risks in reports for women whose mammograms reveal arterial calcium buildup.

“Incidental calcification is reported on other diagnostic studies, such as CT scans, and we envision [breast arterial calcification] not being any different. We suggest that reports include a statement in fine print noting an association of [breast arterial calcification] with cardiovascular disease,” says Dr. Bui.

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