Vascular calcifications in early-breast radiotherapy planning-CT: Opportunistic detection and cardiovascular risk...

To determine the prevalence of vascular calcifications on radiotherapy-planning CTs in women with early breast cancer (BC) and their association with subsequent cardiovascular (CV) events.

Single-center retrospective study of patients who received adjuvant radiotherapy for early BC after breast conserving surgery (2009-2019). Planning CTs were visually assessed for vascular calcifications and the incidence of CV events during follow-up was determined. Comparative analyses of clinical characteristics were conducted across groups stratified by calcification status. Multivariate logistic regression served to evaluate CV event risk, with adjustment for conventional cardiovascular risk factors (CVRF).

The study included 882 patients. The median (IQR) age was 52 (46-62) years. Calcifications were found in 340 patients (38.5 %), 154 (17.5 %) in coronary arteries. Patients with calcifications were significantly older (62 vs. 48 years) and more likely to present CVRF, including hypertension (32.6 % vs. 10.0 %), dyslipidemia (34.7 % vs. 15.3 %), and diabetes (11.5 % vs. 3.1 %). Median follow-up was 8 years (6-10), with 35 patients (4.0 %) experiencing a CV event. Vascular calcification was associated with a significantly higher incidence of CV events (7.1 % vs. 2.0 %; OR = 3.7; 95 % CI: 1.8-7.6). The presence of coronary calcifications, adjusted for age and conventional CVRF, was associated with a 2.86-fold (95 % CI: 1.05-7.78) higher risk of a CV event.

This study shows that vascular calcifications detected incidentally on radiotherapy planning CTs for early BC are common and associated with an increased risk of CV events that is independent of conventional CVRF. These findings suggest that planning CTs in these patients should be routinely reviewed to check for vascular calcifications.