The association between cardiovascular disease risk and breast arterial calcifications identified on screening mammography: A retrospective study.

Abstract

12026 Background: Screening mammography enables early breast cancer detection and improves outcomes. Breast cancer and cardiovascular disease (CVD) share several overlapping risk factors in women. Breast arterial calcifications (BACs) are non-occlusive calcifications of the medial layer of small to medium-sized arteries in the breast that can be identified on mammography. Prior studies have demonstrated an association between BACs and increased cardiovascular risk with growing evidence suggesting that BACs may serve as a non-invasive, low-cost screening tool for CVD. Currently, routine screening for BACs is not uniformly performed. This study aimed to evaluate the prevalence of BACs in screening mammograms, and to characterize associated atherosclerotic cardiovascular disease (ASCVD) risk scores and cardiovascular risk factors among individuals with BACs. Methods: We performed a retrospective analysis of 650 individuals undergoing screening mammography at our institution from 2023 to 2025. Data collected included patient demographics, medical and social history, and cardiovascular risk factors, including blood pressure, diabetes mellitus, and lipid profiles. ASCVD risk scores were calculated for each individual. Statistical analyses, including chi-square test and T-test, were performed to evaluate associations between the presence of BACs, cardiovascular risk factors, and ASCVD scores. Results: Among the 650 women who underwent screening mammography, n = 641 had BI-RADS 1 (negative) or 2 (benign) results, while n = 9 had an abnormal mammogram that subsequently led to a breast cancer diagnosis. BACs were identified in 15.1% of the participants (n = 98). BAC prevalence increased significantly with age: 2.3% among women aged 40-49 years, 8% in those aged 50-59 years, 18.4% in those aged 60-69 years, and 42.2% among women aged 70 years and older (p < 0.001). Among participants with available ASCVD risk data (n = 429), BAC-positive patients had a significantly higher mean 10-year ASCVD risk when compared with BAC-negative patients (14.0% vs 5.23%, p < 0.001). Among the BAC-positive patients, 61.2% were categorized as ASCVD intermediate or high risk versus 20.8% of BAC-negative patients (p < 0.001). BAC-positive patients also exhibited higher mean systolic blood pressure (123.76 vs 120.66 mm Hg, p = 0.042). Hemoglobin A1c, total cholesterol, diastolic blood pressure, and smoking status did not differ significantly between the two groups. Conclusions: Breast arterial calcifications identified on screening mammograms were significantly associated with less favorable cardiovascular risk profiles. Implementation of routine BAC reporting may enable opportunistic CV risk detection during breast cancer screening, potentially leading to earlier preventive interventions.