Abstract
ObjectivesTo investigate the knowledge of radiologists on breast arterial calcifications (BAC) and attitude about BAC reporting, communication to women, and subsequent action.MethodsAn online survey was offered to EUSOBI members, with 17 questions focused on demographics, level of experience, clinical setting, awareness of BAC association with cardiovascular risk, mammographic reporting, modality of BAC assessment, and action habits. Descriptive statistics were used.ResultsAmong 1084 EUSOBI members, 378 (34.9%) responded to the survey, 361/378 (95.5%) radiologists, 263 females (69.6%), 112 males (29.6%), and 3 (0.8%) who did not specify their gender. Of 378 respondents, 305 (80.7%) declared to be aware of BAC meaning in terms of cardiovascular risk and 234 (61.9%) to routinely include BAC in mammogram reports, when detected. Excluding one inconsistent answer, simple annotation of BAC presence was declared by 151/233 (64.8%), distinction between low versus extensive BAC burden by 59/233 (25.3%), and usage of an ordinal scale by 22/233 (9.5%) and of a cardinal scale by 1/233 (0.4%). Among these 233 radiologists reporting BAC, 106 (45.5%) declared to orally inform the woman and, in case of severe BAC burden, 103 (44.2%) to investigate cardiovascular history, and 92 (39.5%) to refer the woman to a cardiologist.ConclusionAmong EUSOBI respondents, over 80% declared to be aware of BAC cardiovascular meaning and over 60% to include BAC in the report. Qualitative BAC assessment predominates. About 40% of respondents who report on BAC, in the case of severe BAC burden, investigate cardiovascular history and/or refer the woman to a cardiologist.Key Points• Of 1084 EUSOBI members, 378 (35%) participated: 81% of respondents are aware of breast arterial calcification (BAC) cardiovascular meaning and 62% include BAC in the mammogram report.• Of those reporting BAC, description of presence was declared by 65%, low versus extensive burden distinction by 25%, usage of an ordinal scale by 10%, and of a cardinal scale by 0.4%; 46% inform the woman and, in case of severe BAC burden, 44% examine cardiovascular history, and 40% refer her to a cardiologist.• European breast radiologists may be ready for large-scale studies to ascertain the role of BAC assessment in the comprehensive framework of female cardiovascular disease prevention.
Highlights
Cardiovascular disease still represents the leading cause of death for women [1]
Of 1084 European Society of Breast Imaging (EUSOBI) members, 378 (35%) participated: 81% of respondents are aware of breast arterial calcification (BAC)
breast arterial calcifications (BAC) and cardiovascular risk and over 60% declared to include BAC in mammography reports when they are present
Summary
Cardiovascular disease still represents the leading cause of death for women [1]. Disparities in mortality rates still subsist by sex among age groups, with less favourable trends in young women [2, 3]. Recommended risk stratification algorithms—including traditional risk factors, sex, race, and ethnicity—do not adequately perform in women, leading to potential risk underestimation and subsequent undertreatment [4, 5]. Traditional cardiovascular risk factors confer different risks for women and men. Unique non-traditional risk factors such as pregnancy complications, oral contraception, hormonal fertility, menopausal therapies, and systemic autoimmune disorders play a crucial role in the complex biological pathway towards cardiovascular disease in women [6]. The estrogenic dysregulation occurring in menopause—and in premature ovarian insufficiency and obesity—favours breast arterial calcifications (BAC) development [7,8,9,10]
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