| Checking for breast artery calcium on
a routine screening mammogram may help determine whether a
patient is at risk for cardiovascular disease,
according to a study presented at the European Congress of Radiology (ECR) in Vienna,
Austria. While mammography should not be the only means of determining heart disease risk,
an annual mammogram could identify women who may not present cardiovascular disease
symptoms, such as chest pain (angina) or shortness of breath (dyspnea).
In the study, the researchers studied the mammogram films of 927 women. All of the women filled out questionnaires about their cardiovascular health and family history. The patients were divided into three groups:
After reviewing the mammogram films, Dr. Pavel Crystal of the Soroku University Medical Center in Beer Sheva, Israel, and his colleagues found that mammography may be an effective and inexpensive screening tool to help determine cardiovascular risk in women. In the study, breast artery calcium was more likely among older women; 43% of the women in group 3 had artery calcium versus 19.5% in group 2 and 3.6% in group 1. The number of women with cardiovascular disease also increased with age; over 25% of group 3 had cardiovascular disease versus only 5.7% of the women in group 1. Atherosclerosis, the narrowing of arteries due to the build-up of cholesterol, fatty substances and/or calcium, can lead to coronary artery disease. Approximately 12,800,000 Americans suffer from coronary artery disease, and every year, more than 500,000 Americans die from heart attacks (myocardial infarction) caused by coronary artery disease. Coronary artery disease is also a major concern in Europe where two million people die from the disease each year. Death rates from coronary artery disease are higher in Northern, Central and Eastern Europe and lower in Southern and Western Europe. For example, the death rate for men aged 35-74 living in Russia is eight times higher than in France and for women it is 12 times higher in Russia than in France. According to Dr. Crystal, who discussed the study at the 2001 ECR conference in March 2001, the researchers compared a variety of risk factors to the presence of cardiovascular disease, and breast artery calcium was determined to be an independent risk factor for heart disease in every age group. Other independent risk factors for heart disease include family history, high blood pressure (hypertension), and diabetes. While mammography can help identify women at risk for cardiovascular disease, Dr. Crystal and his colleagues caution that mammography is not a reliable means of screening patients who are already known to have heart disease. In those cases, other exams, such as an electrocardiogram (EKG), exercise stress test, CT scan, or chest x-ray, are more practical for monitoring heart disease/damage. However, because patients often have no symptoms before experiencing a heart attack, examining breast artery calcium during annual screening mammography may identify those patients who need further cardiac testing. Dr. Crystal’s study also brings up additional concerns of how to determine what/how much breast artery calcium should be considered "normal" or "abnormal." Guidelines for reporting results would have to be set and followed by each radiologist who reads mammogram films to determine which patients should be referred for further cardiac testing. Additional research in this area will likely help to address these issues. The primary purpose of screening mammography is to help detect breast cancer at an early stage, when the changes for successful treatment and survival are the greatest. All women 40 years of age and older should receive annual mammograms in addition to annual physician-performed clinical breast exams and monthly breast self-exams. Women between the ages of 20 and 39 do not typically need screening mammograms unless special circumstances warrant earlier screening (i.e., a strong family history of breast cancer). However, women younger than 40 should still practice monthly breast self-exams and receive physician-performed clinical breast exams at least every three years.
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