AJR:187, July 2006 73 AJR 2006; 187:73–80 0361–803X/06/1871–73 © American Roentgen Ray Society WOMEN’S IMAGING Kataoka et al. Breast Arterial Calcification and Cardiovascular Disease Women’s Imaging • Original Research How Predictive Is Breast Arterial Calcification of Cardiovascular Disease and Risk Factors When Found at Screening Mammography? Masako Kataoka 1 Ruth Warren 2 Robert Luben 3 Joanna Camus 3 Erika Denton 4 Elvis Sala 1 Nicholas Day 3 Kay-Tee Khaw 5 Kataoka M, Warren R, Luben R, et al. Keywords: breast, breast arterial calcification, cardiovascular disease, mammography DOI:10.2214/AJR.05.0365 Received March 2, 2005; accepted after revision April 26, 2005. 1 Department of Radiology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom. Address correspondence to M. Kataoka (mk435@cam.ac.uk). 2 Cambridge Breast Unit, Addenbrooke’s Hospital, University of Cambridge, Hills Rd., Cambridge, CB2 2QQ, United Kingdom. 3 Strangeways Research Laboratory, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom. 4 Department of Radiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom. 5 Clinical Gerontology Unit, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom. OBJECTIVE. The purpose of this study was to examine the relationship between breast ar- terial calcification (BAC), commonly found on mammography, and cardiovascular disease and its risk factors. SUBJECTS AND METHODS. The study population, nested within the European Pro- spective Investigation of Cancer–Norfolk (EPIC–Norfolk) cohort study, consisted of 1,590 women older than 55 years, not taking hormone replacement therapy, and with available screening mammograms. Mammograms were coded by three radiologists for presence or ab- sence of BAC. History of coronary heart disease (CHD), stroke, and diabetes and risk factors for cardiovascular disease (including smoking status, body mass index [BMI], blood pressure, diabetes, and glycosylated hemoglobin [HbA 1c ]) were independently measured from health ex- aminations in the EPIC study. RESULTS. The prevalence of BAC was 16.0%. Women with BAC were significantly older than those without it. BAC was associated with prevalent CHD, but not stroke. The odds ratio of having CHD was 2.54 (95% confidence interval, 1.03–6.30). The sensitivity and specificity were 32.4% and 85.5%, respectively. Except for smoking, which showed an inverse associa- tion, there was no consistent significant association of BAC with cardiovascular disease risk factors including BMI, diabetes, HbA 1c , or lipids. CONCLUSION. BAC found on mammograms was associated with prevalent CHD after adjustment for age, but with low sensitivity. BAC may provide additional information toward identifying cardiovascular disease risk among otherwise healthy women. ardiovascular disease is a leading cause of mortality and morbidity, especially in Western countries. One third of deaths in the United Kingdom are related to cardiovascular dis- ease, causing substantial health care costs and loss of productivity. In the United States, car- diovascular disease is the leading cause of death [1]. Cardiovascular disease results from systemic arterial disease. Arterial calcifica- tion has attracted attention as a marker of overall atherosclerotic disease and therefore is a marker for predicting future cardiovascu- lar events. Numerous studies to estimate cor- onary artery calcification noninvasively by CT have been conducted [2]. The recent meta-analysis for studies with asymptomatic patients showed moderate increased risk (rel- ative risk 2.1; 95% confidence interval [CI], 1.6–2.9) for cardiac events [3]. The use of vascular calcification other than in coronary arteries has also been investigated. Aortic cal- cification identified at chest radiography ap- pears to be independently related to coronary heart disease (CHD), with an increased risk of 1.1 to 1.3 [4–8]. Breast arterial calcification (BAC) is a mam- mographic finding unrelated to cancer and fre- quently observed among elderly women [9, 10]. BAC is classified as medial arterial calci- fication, or Mönckeberg calcification, which is different from intimal calcification [11]. Sev- eral studies suggest that BAC is associated with cardiovascular disease, diabetes, or hyperten- sion and may be used as a marker of arterial disease or cardiovascular disease [10, 12–16]. Although a single case-control study refuted the association between BAC and CHD [17], two cohort studies showed increased risk of cardiovascular disease [10, 15]. The inconsis- tency among the studies may be attributed to the variations in the study population including the age distribution, disease prevalence, or dis- ease risk (Table 1). Mammography screening has attained wide coverage among middle-aged women in C Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved