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Classification and Reporting of Breast Arterial Calcifications: Current State and Ongoing Challenges
Katherine Stephens1, Ronaé K McLin2, Rasha T Ismail3
1Department of Radiology, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Insights
Breast arterial calcifications (BAC) detected during mammography could improve cardiovascular disease (CVD) risk assessment in women. Standardizing BAC reporting and AI quantification is crucial for clinical integration.
Area of Science:
- Cardiology
- Radiology
- Women's Health
Background:
- Cardiovascular disease (CVD) is a leading cause of death in women, with current risk assessments being less effective due to a lack of female-specific factors.
- Mammography, a breast cancer screening tool, incidentally captures images of breast arterial calcifications (BAC), a potential indicator of CVD risk.
- BAC is underutilized in clinical practice due to inconsistent reporting and lack of standardized guidelines.
Purpose of the Study:
- To explore the potential of breast arterial calcifications (BAC) detected on mammograms for improving cardiovascular disease (CVD) risk stratification in women.
- To review current methods for BAC classification and the emerging role of artificial intelligence (AI) in its quantification.
- To understand the attitudes of patients and clinicians towards BAC reporting and its clinical utility.
Main Methods:
- Review of existing literature on breast arterial calcifications (BAC) and their association with cardiovascular disease (CVD).
- Exploration of qualitative and quantitative techniques for BAC classification.
- Discussion of artificial intelligence (AI) applications for automating BAC quantification.
- Analysis of survey data on stakeholder attitudes towards BAC reporting.
Main Results:
- Breast arterial calcifications (BAC) are associated with increased cardiovascular disease (CVD) risk in women.
- Artificial intelligence (AI) shows promise in automating the quantification of BAC.
- Significant variability exists in current BAC reporting practices and stakeholder attitudes.
Conclusions:
- Integrating BAC assessment from mammography could enhance personalized CVD risk assessment for women.
- Standardized reporting guidelines, AI-driven quantification, and cost-effectiveness analyses are needed for routine clinical adoption.
- Further research is required to establish clear clinical follow-up protocols for identified BAC.
Abstract:
Cardiovascular disease (CVD) remains the leading cause of death among women globally, with significant mortality and poorer outcomes compared with men. Traditional CVD risk assessment methods are less effective for women in part due to a lack of consideration for female-specific risk factors and the underrepresentation of women in research. Mammography, primarily used for breast cancer screening, also provides valuable data on breast arterial calcifications (BAC), which are associated with increased CVD risk. Despite its potential, BAC is not routinely reported or used in clinical practice due to variability in reporting practices and the absence of standardized reporting and clinical follow-up guidelines. Various qualitative and quantitative techniques for the classification of BAC and the role of artificial intelligence (AI) in automating BAC quantification have been suggested. Surveys reveal varying attitudes toward BAC reporting among patients, radiologists, and referring clinicians. Despite the potential benefits of BAC reporting for personalized cardiovascular risk assessment, challenges remain, including the need to assess the cost-effectiveness of long-term outcomes, standardized guidelines, and effective follow-up.
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