Breast Arterial Calcification Research Articles

Assessing breast arterial calcification in mammograms and its implications for atherosclerotic cardiovascular disease risk

PurposeBreast arterial calcifications (BAC) are incidentally observed on mammograms, yet their implications remain unclear. We investigated lifestyle, reproductive, and cardiovascular determinants of BAC in women undergoing mammography screening. Further, we investigated the relationship between BAC, coronary arterial calcifications (CAC) and estimated 10-year atherosclerotic cardiovascular (ASCVD) risk. MethodsIn this cross-sectional study, we obtained reproductive history and CVD risk factors from 215 women aged 18 or older who underwent mammography and cardiac computed tomographic angiography (CCTA) within a 2-year period between 2007 and 2017 at hospital. BAC was categorized as binary (present/absent) and semi-quantitatively (mild, moderate, severe). CAC was determined using the Agatston method and recorded as binary (present/absent). Adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated, accounting for age as a confounding factor. ASCVD risk over a 10-year period was calculated using the Pooled Cohort Risk Equations. ResultsOlder age, systolic and diastolic blood pressures, higher parity, and younger age at first birth (≤28 years) were significantly associated with greater odds of BAC. Women with both BAC and CAC had the highest estimated 10-year risk of ASCVD (13.30 %). Those with only BAC (8.80 %), only CAC (5.80 %), and no BAC or CAC (4.40 %) had lower estimated 10-year risks of ASCVD. No association was detected between presence of BAC and CAC. ConclusionsThese findings support the hypothesis that BAC on a screening mammogram may help to identify women at potentially increased risk of future cardiovascular disease without additional cost and radiation exposure.

Coronary and Extra-coronary Subclinical Atherosclerosis to Guide Lipid-Lowering Therapy.

To discuss and review the technical considerations, fundamentals, and guideline-based indications for coronary artery calcium scoring, and the use of other non-invasive imaging modalities, such as extra-coronary calcification in cardiovascular risk prediction. The most robust evidence for the use of CAC scoring is in select individuals, 40-75 years of age, at borderline to intermediate 10-year ASCVD risk. Recent US recommendations support the use of CAC scoring in varying clinical scenarios. First, in adults with very high CAC scores (CAC ≥ 1000), the use of high-intensity statin therapy and, if necessary, guideline-based add-on LDL-C lowering therapies (ezetimibe, PCSK9-inhibitors) to achieve a ≥ 50% reduction in LDL-C and optimally an LDL-C < 70 mg/dL is recommended. In patients with a CAC score ≥ 100 at low risk of bleeding, the benefits of aspirin use may outweigh the risk of bleeding. Other applications of CAC scoring include risk estimation on non-contrast CT scans of the chest, risk prediction in younger patients (< 40 years of age), its value as a gatekeeper for the decision to perform nuclear stress testing, and to aid in risk stratification in patients presenting with low-risk chest pain. There is a correlation between extra-coronary calcification (e.g., breast arterial calcification, aortic calcification, and aortic valve calcification) and incident ASCVD events. However, its role in informing lipid management remains unclear. Identification of coronary calcium in selected patients is the single best non-invasive imaging modality to identify future ASCVD risk and inform lipid-lowering therapy decision-making.

Abstract 16941: Breast Artery Calcification for Primary Prevention of Major Adverse Cardiovascular Outcomes: A New Risk Stratification Tool for Women

Introduction: Reductions in cardiovascular mortality among women lag behind men. There is a critical need for improved primary prevention of major adverse cardiovascular events (MACE) in women. We examined if breast artery calcification (BAC), detected on screening mammograms, prognosticates long-term MACE. Methods: In this retrospective study of consecutive women age 40-75 years without coronary disease from 2011-12, followed for 10 years at Dartmouth-Hitchcock Medical Center, we recorded baseline mammograms, clinical parameters and 10-year MACE risk was estimated via the pooled cohort equation (PCE). The association of BAC and MACE was examined by a multivariable, interactive logistic regression model with MACE as dependent variable, adjusting for confounders and an interaction of BAC with 3 strata of PCE predicted risk: low (&lt;5%), moderate (5-7.5%) and high (&gt;7.5%). The primary endpoint was MACE over 10 years. Results: Among 1216 women, 19% had BAC. Women with BAC were older, had more hypertension and diabetes, and a higher baseline PCE score. Over 10 years of follow-up, 21% of women with BAC developed MACE compared to 11% women without BAC (p&lt;0.001). This association was independent of risk factors and statin use. Among women with low (&lt; 5%) risk of MACE, those with BAC had an 18% incidence of MACE, compared to 7% in women without BAC (OR 2.8, 95% CI 1.5 - 5.0) (Fig 1A). The incremental increase in MACE in patients with BAC decreased with higher PCE-predicted risk. Peak interaction occurred at a PCE-predicted risk of 10% (Fig 1B). Among women with a PCE-predicted risk &lt;10%, BAC was a strong predictor of MACE with an attributable fraction of 20% (Fig 1B). Conclusions: BAC is a strong, independent predictor of MACE, particularly in women at low risk by PCE. Although PCE is used widely to risk stratify women for MACE, our study suggests it severely underestimates risk in women with a low PCE score. Further prospective trials are needed to validate these findings.

Camouflaged cardiac alert: Correlation of breast arterial calcification with carotid intima media thickness for evaluation of cardiac risk

Objectives: To determine the association between breast arterial calcification (BAC) and carotid intima-media thickness (C-IMT) and, in turn, predict the risk of cardiovascular events. To independently access its relationship with other co-morbidities like diabetes mellitus (DM), hypertension (HTN), and menopause with BAC. Material and Methods: A total of 540 patients (270 with BAC and 270 without BAC) in the age group of 40–60 years who underwent mammograms at our institution between April 2021 to October 2021 were included in the study. In addition, an ultrasound was performed to evaluate the intima-media thickness in bilateral common carotid arteries 1 cm proximal to the carotid bulb. The mean C-IMT between the two groups (patients with and without BAC) was compared to understand the relationship between C-IMT and BAC. The independent relationship of BAC was also evaluated with the risk of co-morbidities like DM, HTN, and menopause. Results: The median C-IMT was higher in the group with BAC (0.85 mm, interquartile range (IQR) = 0.2) than in the group without BAC (0.6 mm, IQR = 0.10), which is statistically highly significant with p &lt; 0.001. Further analysis among subgroups of age and DM also revealed IMT to be significantly higher in the group with BAC (0.85 mm, IQR = 0.20) compared to those without BAC (0.6 mm, IQR = 0.15) (p &lt; 0.001). The median age in patients with BAC was significantly higher (57 years, IQR = 10 years) than those without BAC (48 years, IQR = 11.8 years) (p &lt; 0.001). In the group with BAC, a higher proportion of patients were diabetics, hypertensives and had attained menopause, then in the subgroup without BAC. Conclusion: Patients with BAC had higher C-IMT, which in turn correlates with a higher risk of cardiovascular events. Hence, the presence of BAC can be used as a substitute marker for identifying patients with a higher risk of cardiovascular events and for ruling out co-morbidities such as DM and HTN.

Association of breast arterial calcification and carotid atherosclerosis as a marker of cardiovascular risk

Aim. To study the relationship between breast arterial calcification (BAC) and the presence and severity of carotid atherosclerosis.Material and methods. We analyzed 4274 digital mammograms of women who underwent diagnostic mammography. In addition to the standard diagnosis of breast diseases, BAC was assessed in all mammograms. The study included 198 women aged 40-74 years, who made up 2 groups with and without BAC, each consisting of 99 people, formed on a case-control basis. The severity of BAC was assessed by a 12-point score. Duplex ultrasound of extracranial arteries determined plaque presence, the severity of CA stenosis (in percent) and intima-media thickness (IMT). All women underwent physical and laboratory examinations, electrocardiography, and were interviewed using a questionnaire assessing socio-demographic data, menopausal status, risk factors, and diseases.Results. The groups did not differ in lipid levels, blood glucose, body mass index, incidence of hypertension, diabetes, or smoking. Women with BAC had a higher incidence of menopause (94,9% vs 84,8%, p=0,033), coronary artery disease (13,1% vs 4,2%, p=0,039) and osteoporosis (18,2% vs 6,1%, p=0,016) in history. In women with BAC, at least one carotid plaque was observed significantly more often than in those without BAC — in 79,8% and 60,6% of cases, respectively (p=0,005). Women with BAC compared with women without BAC had a greater plaque number (1,0 [1,0; 3,0] vs, 1,0 [1,0; 2,0], p&lt;0,001) and a more severe carotid stenosis, assessed by maximum (25,0 [17,5; 35,0] vs 20,0 [0,0; 27,5], p=0,001), total (30,0 [20,0; 92,5] vs 25,0 [0,0; 50,0], p&lt;0,001) and mean arterial stenosis (25,0 [17,5; 30,0] vs 20,0 [0,0; 25,0], p=0,001). For the first time, a positive relationship was revealed between the severity of carotid atherosclerosis and BAC as follows: women with greater severity of maximum and total carotid stenosis had more severe BAC (p=0,018 and p=0,003, respectively). There was no association between BAC and IMT (p=0,115).Conclusion. BAC is associated with a higher incidence and severity of carotid atheromatosis. A positive relationship was found between the severity of BAC and carotid stenosis. The data obtained confirm the prospects of mammography as a screening technique for identifying individuals with an increased cardiovascular risk.

Patient Notification About Breast Arterial Calcification on Mammography: Empowering Women With Information About Cardiovascular Risk.

To assess the impact of informing women about the presence of breast arterial calcification (BAC) on mammography by determining whether those notified about the presence of BAC would seek cardiovascular evaluation. This IRB-approved prospective study included 494 patients who underwent screening mammography between June 8, 2021, and April 22, 2022. Mammograms were reviewed by a radiologist, and patients were notified via e-mail about the presence or absence of BAC. Patients with BAC were advised to discuss the results with their physicians and were surveyed 3 months later. Frequencies and proportions were calculated for study participation, presence of BAC, survey participation, health actions, and perceptions. Confidence intervals were calculated for proportions of health actions and perceptions. Of 494 study participants, 68/494 (13.8%; 95% CI: 10.9%-17.1%) had BAC detected on mammography and 42/68 (61.8%; 95% CI: 61.1%-62.1%) with BAC completed the follow-up survey at 3 months. Of these 42 survey respondents, 24/42 (57.1%; 95% CI: 41.1%-72.3%) reported discussing results with their primary care physician (PCP) or a cardiologist. In addition, 34/42 (81.0%; 95% CI: 65.9%-91.4%) reported finding it helpful to receive information about BAC and 32/42 (76.2%; 95% CI: 60.6%-88.0%) believed all women should be informed about BAC after mammography. After notification about the presence of BAC on screening mammography, the majority (57.1%) of survey respondents reported discussing the results with a PCP or cardiologist. These results suggest that providing mammography patients with information about BAC may promote preventive cardiovascular health.

The frequency of breast artery calcification during screening mammography of Uzbek women older than 40 years old

The frequency of breast artery calcification during screening mammography of Uzbek women older than 40 years old

Cutaneous vascular calcifications in patients with chronic kidney disease and calcific uremic arteriolopathy: a cross-sectional study.

Calcific uremic arteriolopathy is a life-threatening cutaneous condition in patients with chronic kidney disease. Often, clinical diagnosis is accompanied by histopathologic evaluations demonstrating vascular calcium deposits. We aimed to investigate the presence of cutaneous calcifications in non-lesional tissue in patients with chronic kidney disease, and the relation to systemic vascular calcification. We investigated the presence of cutaneous vascular calcifications in non-lesional skin biopsies from patients with current or previous calcific uremic arteriolopathy and patients with different stages of chronic kidney disease without calcific uremic arteriolopathy, and explored their association with vascular calcification in other vascular beds. Systemic vascular calcification was examined by mammography and lumbar X-ray. Thirty-nine adults were enrolled (current or previous calcific uremic arteriolopathy, n = 9; end-stage chronic kidney disease, n = 12; chronic kidney disease stage 3b-4, n = 12; healthy controls, n = 6). All calcific uremic arteriolopathy patients had end-stage kidney disease. Cutaneous vascular calcifications were not present in any of the non-lesional skin punch biopsies. Breast arterial calcification was demonstrated in patients with calcific uremic arteriolopathy (75%) and chronic kidney disease (end-stage 67% and stage 3b-4 25%, respectively), but in none of the controls. All chronic kidney disease patients had systemic calcification on lumbar X-ray (median score 21, 22, and 15 in patients with calcific uremic arteriolopathy, end-stage kidney disease and chronic kidney disease stage 3b-4). The serum calcification propensity was significantly different between groups. Despite a high burden of systemic vascular calcification, cutaneous calcium deposits in non-lesional tissue could not be demonstrated histopathologically in patients with chronic kidney disease (with or without current or previous calcific uremic arteriolopathy). Further studies to determine whether these findings are representative or attributed to other factors are warranted.

Artificial Intelligence Software Demonstrates High Performance for Breast Arterial Calcification Detection on Mammography

Artificial Intelligence Software Demonstrates High Performance for Breast Arterial Calcification Detection on Mammography

Sex, Racial, and Ethnic Disparities in Acute Coronary Syndrome: Novel Risk Factors and Recommendations for Earlier Diagnosis to Improve Outcomes.

In this review, sex, racial, and ethnic differences in acute coronary syndromes on a global scale are summarized. The relationship between disparities in presentation and management of acute coronary syndromes and effect on worse clinical outcomes in acute coronary syndromes are discussed. The effect of demographic, geographic, racial, and ethnic factors on acute coronary syndrome care disparities are reviewed. Differences in risk factors including systemic inflammatory disorders and pregnancy-related factors and the pathophysiology underlying them are discussed. Finally, breast arterial calcification and coronary calcium scoring are discussed as methods to detect subclinical atherosclerosis and start early treatment in an attempt to prevent clinical disease.

Incidental Breast Arterial Calcifications and Assessment of Coronary Artery Disease Risk: A Review and Recommendation.

Coronary artery disease (CAD) continues to be the leading cause of morbidity and mortality in women, contributing to about 20%, or nearly 400,000, of female deaths annually in the United States. Despite their significant burden from CAD, women have been traditionally underrepresented in trials, and therefore, there is still much to be studied regarding the sex-based variations that have been reported regarding the pathophysiology, clinical presentation, efficacy of diagnostic workup, and response to therapy in CAD. Previous studies have reported that breast arterial calcifications, commonly found incidentally on screening mammography, may be associated with risk of CAD; however, there are currently no specific guidelines concerning reporting and quantification practices, as well as further workup recommendations for patients who are found to have vascular calcifications. Thus, the question remains whether breast arterial calcifications can serve as a sex-specific marker for CAD, and whether there is enough evidence to support the use of mammography as a screening tool for CAD in women. In this review, we will summarize the current understanding of cardiovascular disease in women, the existing literature regarding breast arterial calcifications and current reporting practices, and the association of vascular calcifications with CAD risk; based on the collected evidence, we will make a recommendation whether screening mammography and breast arterial calcifications should be used to assess CAD risk, and if so, what additional workup, if any, we recommend in women found to have breast arterial calcifications on imaging.

Correlation of breast arterial calcification with overall survival in patients with breast cancer.

e12501 Background: Calcifications in breast tissue are common and indicate an array of conditions. Based on pattern of calcifications it indicate cancerous/ precancerous changes. Similarly vascular calcifications indicate a systemic vasculopathy. Aim of this study is to correlate Breast Arterial Calcification (BAC) with overall survival/all cause mortality in patients with breast cancer. Methods: It is a retrospective analysis of all breast cancer patients diagnosed across 3 specialty hospitals In the period of 2013-2017 with at least 5 years of follow up. All cause mortality, breast cancer specific mortality were measured. The comparison was made between the patients with no calcifications (Gr I), vascular calcifications (GrII) ductal calcifications (Gr III), and any breast calcification (Gr IV). Results: The baseline characters of all these groups and the treatment received were balanced. The median survival of the Groups were 43.6+22.6 mo vs 28.6+14.2 mo vs38.5+20.2 mo vs41.6+22.3 months (p=&lt;0.02). Presence of vascular calcifications confers shorter overall survival and the main reason being death due to cardiovascular events. The risk is more in presence of co-morbid conditions (&gt;2 have increased risk of 2.8 fold compared to less than 2), which were defined as diabetes, hypertension, dyslipidemia, history of cardiac illness in family, obesity. Those who received Adriamycin based therapy have 1.16 times higher risk than those who did not. Those who smoke are 3.2 times at higher risk than non smokers to have cardiovascular event in presence of breast arterial calcification. Alcohol did not have any impact. Conclusions: BAC is an important marker to predict underlying vasculopathy and risk of coronary cardiac diseases. It confers poor prognosis and reduced overall survival compared to those who do not have it. The challenges to assess CAD risk through CT/angio on community basis is high. Mammograms are being done annually across nations as a routine basis. Risk factors of breast cancer and CAD are common. The cancer detection rates of mammo as &lt;0.2% compared to arterial calcifications, which is almost 12.8%. A simple extra attention towards BAC could help in preventing cardiac related mortality in women both with and without cancer. [Table: see text] [Table: see text]

Detection and quantification of breast arterial calcifications on mammograms: a deep learning approach

ObjectiveBreast arterial calcifications (BAC) are a sex-specific cardiovascular disease biomarker that might improve cardiovascular risk stratification in women. We implemented a deep convolutional neural network for automatic BAC detection and quantification.MethodsIn this retrospective study, four readers labelled four-view mammograms as BAC positive (BAC+) or BAC negative (BAC−) at image level. Starting from a pretrained VGG16 model, we trained a convolutional neural network to discriminate BAC+ and BAC− mammograms. Accuracy, F1 score, and area under the receiver operating characteristic curve (AUC-ROC) were used to assess the diagnostic performance. Predictions of calcified areas were generated using the generalized gradient-weighted class activation mapping (Grad-CAM++) method, and their correlation with manual measurement of BAC length in a subset of cases was assessed using Spearman ρ.ResultsA total 1493 women (198 BAC+) with a median age of 59 years (interquartile range 52–68) were included and partitioned in a training set of 410 cases (1640 views, 398 BAC+), validation set of 222 cases (888 views, 89 BAC+), and test set of 229 cases (916 views, 94 BAC+). The accuracy, F1 score, and AUC-ROC were 0.94, 0.86, and 0.98 in the training set; 0.96, 0.74, and 0.96 in the validation set; and 0.97, 0.80, and 0.95 in the test set, respectively. In 112 analyzed views, the Grad-CAM++ predictions displayed a strong correlation with BAC measured length (ρ = 0.88, p < 0.001).ConclusionOur model showed promising performances in BAC detection and in quantification of BAC burden, showing a strong correlation with manual measurements.Clinical relevance statementIntegrating our model to clinical practice could improve BAC reporting without increasing clinical workload, facilitating large-scale studies on the impact of BAC as a biomarker of cardiovascular risk, raising awareness on women’s cardiovascular health, and leveraging mammographic screening.Key Points• We implemented a deep convolutional neural network (CNN) for BAC detection and quantification.• Our CNN had an area under the receiving operator curve of 0.95 for BAC detection in the test set composed of 916 views, 94 of which were BAC+ .• Furthermore, our CNN showed a strong correlation with manual BAC measurements (ρ = 0.88) in a set of 112 views.

The association between breast arterial calcification and atherosclerotic cardiovascular disease in an Australian population-based breast cancer case–control study

PurposeAtherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality. Breast arterial calcification (BAC) on mammograms is not associated with breast cancer risk. However, there is increasing evidence supporting its association with cardiovascular disease (CVD). This study examines the association between BAC and ASCVD and their risk factors within an Australian population-based breast cancer study.Materials and methodsData from the controls who participated in the breast cancer environment and employment study (BCEES) were linked with the Western Australian Department of Health Hospital Morbidity database and Mortality Registry to obtain ASCVD outcomes and related risk factor data. Mammograms from participants with no prior history of ASCVD were assessed for BAC by a radiologist. Cox proportional hazards regression was used to examine the association between BAC and later occurrence of an ASCVD event. Logistic regression was used to investigate the factors associated with BAC.ResultsA total of 1020 women with a mean age of 60 (sd = 7.0 years) were included and BAC found in 184 (18.0%). Eighty (7.8%) of the 1020 participants developed ASCVD, with an average time to event of 6.2 years (sd = 4.6) from baseline. In univariate analysis, participants with BAC were more likely to have an ASCVD event (HR = 1.96 95% CI 1.29–2.99). However, after adjusting for other risk factors, this association attenuated (HR = 1.37 95% CI 0.88–2.14). Increasing age (OR = 1.15, 95% CI 1.12–1.19) and parity (pLRT < 0.001) were associated with BAC.ConclusionBAC is associated with increased ASCVD risk, but this is not independent of cardiovascular risk factors.

Abstract P678: On the Relationship of Breast Arterial Calcification With Coronary Artery Calcification: A Pilot Study

Breast arterial calcification (BAC) detected in mammograms is an emerging risk-enhancing factor for atherosclerotic cardiovascular disease (ASCVD). The predictive value of coronary artery calcification (CAC) for risk of ASCVD above and beyond traditional risk factors is well-established in women. However, there are few studies that have simultaneously evaluated BAC and CAC. The Multiethnic study of breast arterial calcium gradation and cardiovascular disease (MINERVA) cohort, a large, racially and ethnically diverse cohort of postmenopausal women aged 60-69 (n=5,059) was recruited in 2012-15 at Kaiser Permanente of Northern California (KPNC). BAC was assessed using a densitometry method, and presence of BAC was defined as a calcium mass score&gt;0 mg. Searching the electronic health record up to 5 years after baseline, we identified 33 women (39% non-white) who underwent cardiac computed tomography (CT) because of medical indication. BAC was present in 33% (11/33) whereas CAC (Agastston score &gt;0) was present in 61% (20/33). Nine (27%) were BAC and CAC -; 7 (21%) were BAC and CAC+; 4 (12%) were BAC+ and CAC -; and 13 (39%) were BAC - and CAC+. The correlation between log (BAC+1) and log (CAC+1) was 0.45 (p=0.02) in the entire sample (n=33) and was 0.68 (p=0.09) in the 7 women who were BAC and CAC+. The concordance, sensitivity, specificity, PPV, NPV for BAC considering CAC as the gold standard were 0.48, 0.35, 0.69, 0.63 and 0.41, respectively. The unadjusted odds ratio for log (CAC+1)&gt;0 as a function of Log (BAC+1) was 1.21 (95% CI, 0.27-5.38; p=0.80). Although our sample was small, the findings reflect real-world evidence and suggest that BAC and CAC are not entirely overlapping and thus may convey independent predictive information for ASCVD.

Abstract P337: Determinants and Influence of Breast Arterial Calcifications on Risk of Cardiovascular Disease

Background: Breast arterial calcifications (BAC) are incidentally observed on screening mammography. BAC has been shown to be associated with the presence of coronary artery calcification (CAC) and increased risk of coronary artery disease (CAD). Given that population-based mammography is currently recommended to women, the evaluation of BAC may be important in identifying high-risk women without additional cost or radiation exposure. Aims: We sought to identify reproductive and cardiovascular risk factors associated with the presence of detectable BAC and CAC in women participated to mammography screening. Also, we aimed to determine the association between BAC and presence of CAC. Further, we investigated presence of BAC, CAC and estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD). Methods: In this cross-sectional study, reproductive history and CVD risk factors were obtained in 215 women ≥ 18 years of age that underwent mammography and cardiac computed tomographic angiography (CCTA) within 2 years of each other between January 2007 and September 2017 at Weill Cornell Medicine/ New York Presbyterian hospital (WCM/NYP). BAC was recorded in two ways: a binary scale (presence/absence) and a semi-quantitative scale (mild, moderate, severe). CAC was calculated using the Agatston method and was recorded as a binary variable (presence/absence). Information regarding reproductive history and CVD risk factors, medical history, and relevant demographics were obtained by chart review. Odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for age at study entry as a potential confounder, were estimated. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was calculated using the Pooled Cohort Risk Equations. Results: The odds of presence of BAC increased with increasing age . Women age ≥60 had a near 6-fold higher odds of BAC (OR = 5.77; 95% CI = 2.45 to 16.00) compared with women &lt;60 years old. Other factors associated with presence of BAC after controlling for age were diastolic blood pressure ≥80 ( P = 0.0008), systolic blood pressure ≥140 ( P = 0.0009), number of children (P = 0.01). Younger age at first birth (≤28 years) was associated with 3-fold higher odds of BAC compared with women with age at first birth &gt;28 years. Except for age at study entry, the only factor associated with presence of CAC was hyperlipidemia ( P = 0.002). We found no association between presence of BAC with CAC. We observed women with presence of both BAC and CAC had the highest estimated 10-year risk of ASCVD: 18.54%, followed by presence of BAC but absence of CAC 11.65%, absence of BAC and presence of CAC 6.01%, and women with no BAC and no CAC presence had a mean 10-year risk of ASCVD of 5.25%. Conclusions: These findings support the value of BAC in identifying women at potentially increased risk of future cardiovascular disease without additional cost and radiation exposure.

Abstract P522: Breast Arterial Calcification Predicts Heart Failure Across Racial and Ethnic Groups

Introduction: Breast arterial calcification (BAC), which can be seen on mammograms, is emerging as a risk stratification tool for cardiovascular disease (CVD) outcomes including heart failure, though how prediction varies by race and ethnicity is unknown. Methods: This single-center, retrospective study included 18,092 women age ≥40 years who had a digital mammogram between 2008-2016 and clinical follow-up through 2019. BAC was quantified using an automated algorithm (CureMetrix), resulting in a continuous Bradley score. Heart failure (HF) events and self-reported race and ethnicity were obtained via medical records. Adjusted hazard ratios (aHR) were calculated using Cox proportional hazard regression models with interaction terms to evaluate the effect of race and ethnicity on the association between BAC (presence/absence; or Bradley score quartile among those with BAC) with incident HF, adjusted for age, diabetes, smoking, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and history of CVD and chronic kidney disease. Results: Mean age was 57±11 years with 11,319 (63%) of women White, 907 (5%) Black, 1,694 (9%) Hispanic, 2,321 (13%) Asian, and 1,851 (10%) Other. Over a median follow-up of 3.0 years, 149 of the 4,076 women with BAC (3.7%) developed HF compared to 149 of the 14,016 women without BAC (1.1%). Presence of BAC was associated with incident HF (aHR 1.38, 95% CI 1.21-1.58, p&lt;0.001) overall and among all racial and ethnic groups, with increased risk seen for increasing quartiles of Bradley score (aHR 1.17 in the first, 1.30 in the second, 1.79 in the third, 1.69 in the fourth; p-trend&lt;0.001). The presence of BAC was an even stronger predictor of HF in Black women compared to White women ( Figure ; aHR 1.51 [1.00-2.30], p interaction=0.05). Conclusions: The presence and degree of BAC on a mammogram is an independent predictor of HF and may serve as an especially strong risk factor among Black women.

Breast arterial calcification is associated with incident atrial fibrillation among older but not younger post-menopausal women.

The goal of this study was to examine the association of breast arterial calcification (BAC) presence and quantity with incident atrial fibrillation (AF) in a large cohort of post-menopausal women. We conducted a longitudinal cohort study among women free of clinically overt cardiovascular disease and AF at baseline (between October 2012 and February 2015) when they attended mammography screening. Atrial fibrillation incidence was ascertained using diagnostic codes and natural language processing. Among 4908 women, 354 incident cases of AF (7%) were ascertained after a mean (standard deviation) of 7 (2) years of follow-up. In Cox regression adjusting for a propensity score for BAC, BAC presence vs. absence was not significantly associated with AF [hazard ratio (HR) = 1.12; 95% confidence interval (CI), 0.89-1.42; P = 0.34]. However, a significant (a priori hypothesized) age by BAC interaction was found (P = 0.02) such that BAC presence was not associated with incident AF in women aged 60-69 years (HR = 0.83; 95% CI, 0.63-1.15; P = 0.26) but was significantly associated with incident AF in women aged 70-79 years (HR = 1.75; 95% CI, 1.21-2.53; P = 0.003). No evidence of dose-response relationship between BAC gradation and AF was noted in the entire cohort or in age groups separately. Our results demonstrate, for the first time, an independent association between BAC and AF in women over age 70 years.

Difference-of-Gaussian generative adversarial network for segmenting breast arterial calcifications in mammograms

Breast arterial calcifications (BACs) are amongst the different types of benign calcifications observed on mammograms. BACs have been found to correlate with cardiovascular risk factors, cardiovascular mortality, and coronary artery disease (CAD). Considering that women are recommended to undergo routine screening mammography for the early detection of breast cancer, identifying BACs on mammograms could help identify women at risk of cardiovascular diseases (CVD) without the additional cost or radiation of other tests, such as coronary artery computed tomography (CT). In this paper, we present a difference of Gaussian generative adversarial network (DoG-GAN) model for segmenting BACs in mammograms. It combines the multi-scale difference of Gaussian (DoG) pyramid with the U-net as a generator of the GAN. This approach allows the model to explore image details at each scale and exploit the edge information to effectively segment BACs. We evaluated the performance of our model on a set of synthetic 2D images from digital breast tomosynthesis exams (DBT) collected and prepared for this task. The experimental results show that our model outperforms the state-of-the-art methods.

Detecting Breast Arterial Calcifications in Mammograms with Transfer Learning

Cardiovascular diseases, which include all heart and circulatory diseases, are among the major death-causing diseases in women. Cardiovascular diseases are not subject to screening programs, and early detection can reduce their mortal effect. Recent studies have shown a strong association between severe Breast Arterial Calcifications and cardiovascular diseases. The aim of this study is to use the screening programs for breast cancer to detect the high severity of BACs and therefore to obtain indirect information about coronary diseases. Previous attempts in the literature on the detection of BACs from digital mammograms still need improvements to be used as a standalone technique. In this study, a dataset of mammograms with BACs is divided into 4 grades of severity, and this study aims to improve their classification through a transfer learning approach to overcome the need for a large dataset of training. The performances achieved in this study by using pre-trained models to detect four Breast Arterial Calcifications severity grades reached an accuracy of 94% during testing. Therefore, it is possible to benefit from the advantage of Deep Learning models to define a rapid marker of BACs along Brest Cancer screening programs.