Breast Arterial Calcification in Screening Mammograms and its Correlation with Carotid Intima Media Thickness: A Cross-sectional Study

Abstract

Introduction: Atherosclerosis is a leading cause of cardiovascular mortality worldwide. According to American Cancer Society (ACS) guidelines, screening mammography is optional for all women above the age of 40 years to detect breast cancer early. Incidentally, Breast Arterial Calcification (BAC) can be observed in mammograms. Women with BAC and additional risk factors like diabetes or hypertension may be referred for cardiovascular risk assessment in the future if there is a significant correlation between Carotid Intima Media Thickness (CIMT) and BAC. Aim: To assess BAC among women undergoing screening mammography and determine the correlation between BAC and CIMT. Materials and Methods: A cross-sectional study was conducted on 152 women who underwent screening mammography in the Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur, Kerala, India from May 2021 to October 2022. The presence and grading of BAC were determined using the Seimens Mammomat 1000 mammography unit, which captured two standard views: the Mediolateral Oblique (MLO) and Craniocaudal (CC) views. CIMT was measured using B-mode ultrasonography with an 8-13 MHz linear transducer, taking measurements from two contiguous sites at 1 cm intervals and calculating the average. Statistical significance was assessed at a 5% level, and the association was determined using Spearman’s rho correlation. Results: The mean age of the study population was 55.7±11.05 years. Among them, only 37 (24.3%) showed the presence of calcification in the breast arteries. The mean CIMT was 0.92±0.25 mm in the BAC (+) group and 0.72±0.24 mm in the BAC (-) group (p-value=0.001). Conclusion: The authors developed a BAC grading method after studying various previous studies and the present study found a significant positive correlation between the presence of BAC and CIMT.