May 23, 2022 by John Fernandez
Lynn Women’s Institute is Setting the Standard for Detecting Risk of Heart Disease in Mammograms
A finding of breast artery calcifications on a mammogram is a potentially vital signal that a woman undergoing breast cancer screening is at risk for cardiovascular disease. The Schmidt Family Center for Breast Care at Christine E. Lynn Women’s Health and Wellness Institute, part of Baptist Health, has made the protocol of identifying breast artery calcifications a standard service, which is unique to South Florida and most mammography centers nationwide.
About 40 percent of breast cancers present with calcifications in breast tissue. Breast imagers (specialized radiologists) can easily differentiate calcifications related to breast disease from those in the breast arteries. Arterial calcifications refer to calcium build-up within the middle layer of the breast’s arterial wall. It can be related to aging, type 2 diabetes, high blood pressure, and can be a marker of artery stiffening reflecting cardiovascular disease.
(Watch video: Hear from radiologist Kathy Schilling, M.D., medical director of the Christine E. Lynn Women’s Health & Wellness Institute, and Heather Johnson, M.D., a preventive cardiologist with the Institute. Video by Alcyene de Almeida Rodriguez.)
“We as radiologists are very attuned to looking for calcifications on the mammogram,” explains radiologist Kathy Schilling, M.D., medical director of the Christine E. Lynn Women’s Health & Wellness Institute at Boca Raton Regional Hospital. “I was intrigued by research that has been coming out over the last several years, particularly out of the cardiovascular literature, where there was an association between calcifications in the breast arteries and calcifications found in the heart, which puts those patients at risk for cardiovascular events.”
Institute Will Lead Research on Breast Artery Calcifications
Now, the Institute is poised to further set the national standard for finding breast artery calcifications on mammograms with clinical research that will provide a more detailed assessment of the effectiveness of this protocol. The lead investigators will be Dr. Schilling and Heather Johnson, M.D., a preventive cardiologist with the Christine E. Lynn Women’s Health & Wellness Institute.
“Unfortunately, heart disease in women is the No. 1 cause of death,” said Dr. Johnson. “We are also seeing recent literature that adults under 55 years-old are having higher rates of heart attack and stroke. Being able to identify breast arterial calcification, and sharing this information with the results of her mammogram, will help accelerate a woman’s awareness and education about her own heart disease risk.“
“Research has shown that about 10 to 12 percent of asymptomatic, healthy women, will have breast artery calcifications,” said Dr. Schilling. “We hope that these research findings will get more health systems on board to start offering this type of program for their patients.”
How the Program Works at Lynn Women’s Institute
“The presence of calcified arteries in your breast is a noncancerous, incidental finding, but is an indication that you may be at increased risk for cardiovascular disease,” reads a brochure provided to every patient who has her mammogram at the Lynn Women’s Institute. Determining the presences of arterial calcifications takes no extra time or cost for the patients, stresses Dr. Schilling.
“It’s so important to give the patients the opportunity to learn whether they may be at risk for cardiovascular disease,” said Dr. Schilling. “And we can do that at no additional cost to the patient, no additional radiation dose, and no additional time. By sharing this incidental finding found on the mammogram with patients, we are empowering women to take charge of their heart health.”
Dr. Schilling explains that when a patient is advised of the incidental finding of arterial breast calcifications with her screening mammogram results, if she does not have a physician, a patient navigator is available to assist with a referral to a cardiovascular specialist for a preventive cardiovascular evaluation to help guide them through understanding their personal heart disease risk.
Cardiovascular Testing to Find Cause of Arterial Calcification
“Many factors contribute to the development of breast artery calcification and heart disease,” said Dr. Johnson. “Our preventive cardiology visit includes an individualized assessment of possible risk factors for heart disease. Some women may not be aware of the impact of diabetes, high cholesterol, or high blood pressure, or how other health issues may contribute to heart disease. As women, we tend to be very preoccupied caring for others. This may be one of the few times women can dedicate preventive cardiovascular care to themselves.”
As part of a preventive cardiovascular evaluation, additional testing may be recommended, such as a coronary artery calcium scan, which is a noninvasive CT scan that measures any calcium buildup in the walls of the heart’s blood vessels, said Dr. Johnson.
As far as the prevalence of breast arterial calcification among women in Palm Beach County and the rest of South Florida, Dr. Johnson’s sees a higher than the national average of about 12 percent. “We are seeing a prevalence that is higher, on average, closer to 20 percent.”
While women who schedule mammograms at the Institute have breast cancer at top-of-mind, the Schmidt Family Center for Breast Care helps those at risk for heart disease or cardiovascular events take further action to improve their heart health.
“We know that breast cancer is not preventable because we can’t change our family history and we can’t change our breast density — and so we rely on early detection,” said Dr. Schilling. “But cardiovascular disease is different. It’s a preventable disease. Through lifestyle modification, women can prevent progression of heart disease by treating diabetes or hypertension, maintaining an optimum weight, and reducing other risk factors. Our patients come to us for breast cancer screenings because they want to be proactive when it comes to managing their health. It’s really important for us as radiologists to let women know that they may be at risk to develop a cardiovascular event.”
To schedule an appointment at the Christine E. Lynn Women’s Health & Wellness Institute for a mammogram or preventive cardiology evaluation, call 561-955-4HER (955-4437).