Relationship between breast arterial calcifications seen on screening mammograms and age‐related macular degeneration

Abstract

Age-related macular degeneration (AMD) is a complex multifactorial disease, and several factors have been associated with its occurrence, such as age, genetic factors or cardiovascular disease. Breast arterial calcifications (BACs) are a common finding on screening mammograms (8–12%) of women (Maas et al. 2006; Pidal et al. 2009) and may be an important marker for generalized vascular disease (Maas et al. 2006; Pidal et al. 2009; Ahn et al. 2011; Schnatz et al. 2011). Both BAC and AMD have some clinical and biochemical vascular risk factors in common. We revised digital mammograms and records from women, finding out that 8.5% of the total population presented BAC. Seventy-one women with BAC and 50 without BAC accepted to go into the study. Demographic and clinical evaluation, ophthalmic examination and biochemical serum analysis (plasma total homocysteine (tHcy) and high-sensitivity C-reactive protein (hs-CRP)) were performed. Each ophthalmic assessment included a 45° colour digital retinography and a macular HD-optical coherence tomography (OCT) examination. Macular area was evaluated with a standard grid template included in the retinography system. Drusen <63 μm were considered as small, ≥63 μm but <125 μm as intermediate and ≥125 μm as large. We used a minimal modification of the CARMS system (Seddon et al. 2006) and classified AMD into 1 to 4 mutually exclusive stages as follows: in level 1, eyes without drusen or <10 small drusen without pigment abnormalities; in level 2, eyes with ≥10 small drusen or <15 intermediate drusen or the presence of pigmentary abnormalities; in level 3, eyes with large drusen or ≥15 intermediate drusen; in level 4, eyes with geographical atrophy or signs of neovascular AMD. Age-related macular degeneration was diagnosed if any of the criteria in each level was present in at least one eye. Optical coherence tomography images were an additional evaluation about injuries compatible with AMD, such as retinal pigmentary epithelial abnormalities, drusen, and atrophic or neovascular disorders. Of the 121 women included in the study, 71 had BAC and 76 had AMD. Women with BAC and AMD had significantly higher age mean (p = 0.0001 and p = 0.002, respectively), and significantly higher serum levels of homocysteine and hs-CRP (data not shown). Women with BAC had a significantly higher percentage of cases with intermediate or large drusen (p = 0.015), OCT signs (p = 0.0016) or AMD (p = 0.0001) than women without BAC (Table 1). Women with BAC had also a significantly more advanced grade of AMD (p = 0.0001). Women in 61–70 range have a more advanced AMD level than women in 50–60 range, as shown in level 3 (7 versus 1) or level 4 (4 versus 0), respectively, demonstrating that age is a factor related with a more advanced AMD level. Multivariate analysis showed that hypertension (OR: 3.1; confidence interval (CI) 95%: 1.2–8.1; p = 0.02), obesity (OR: 0.1; CI 95%: 0.02–0.7; p = 0.021) and BAC (OR: 8.4; CI 95%: 2.3–18.2; p = 0.0001) were independent factors associated with AMD. These data led us to consider that pathologic changes in the breast vessels may be paralleled by those in the retina and that the presence of BAC on mammography may be associated with an increased risk of retinopathy related with vascular damage. Screening mammography may be a very attractive tool to detect potential markers for increased risk of other diseases, such as cardiovascular disease or AMD. This is a preliminary study of a possible relationship between systemic arterial calcifications and AMD, which evaluation in mammograms from breast cancer screening might be a useful tool to identify women with AMD or with high risk to develop this process. Further studies in this context may contribute to an improvement in the detection and the design of preventive strategies for AMD and assess cost-effectiveness to implement this measure in women population. The authors declare that they have no conflict of interest.