Abstract
Background Cardiovascular disease (CVD) remains the number one cause of death in women. Current screening tools in this population do not identify all women who are at risk. Screening for breast artery calcification (BAC) via routine mammography is emerging as a risk enhancing tool; however, how risk prediction varies by age is unknown. Methods This single-center, retrospective study included 14,544 women who had a digital mammogram from 2008-2016. BAC was quantified with the Bradley score derived from an automated algorithm developed by CureMetrix; presence of BAC was defined as a Bradley score ≥10. Mortality data were collected after index mammogram by review of medical records. Adjusted hazard rations (aHR) were calculated using Cox regression models with interaction terms to evaluate the influence of age on the association between presence of BAC and mortality, after adjusting for age, diabetes, medications, race, current smoking, systolic blood pressure, total and HDL cholesterol, plus prior CVD. Results In the overall study population 8% had diabetes, 30% hypertension, 30% hyperlipidemia and 5% were current smokers. BAC was detectable in 522 of 9,027 (6%) of women age 40-59 years, 657 of 2,865 (23%) 60-69 years, and 702 of 1,358 (52%) 70+. Over mean follow-up of 4.2 years, there were 328 deaths (15.1%) among women with BAC. When subjects were separated by age, presence of BAC was associated with mortality among younger women (40-59 years: aHR 1.50 [95% CI 1.06-2.12]; 60-69 years: aHR 1.59 [95% CI 1.19-2.12], Figure ). Among women ages 70+, BAC was not a significant predictor of mortality (aHR 1.11 [95% CI 0.86-1.43]). There was a significant negative interaction effect of age with BAC for prediction of mortality (p < 0.001). Conclusions: BAC is predictive of mortality, especially in younger women. BAC may be a useful screening adjunct to traditional CVD risk factors, to help identify women at an early age who may benefit from more targeted preventive measures. Figure
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