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Mammograms may also spot heart disease, doctors say

April 4, 2016


NEW YORK ó Doctors in Manhattan are proposing dual duty for mammograms because the screening technology can spot a key sign of heart disease, which kills 10 times more women than breast cancer.

Digital mammography is an underappreciated tool that can provide vivid images of blood vessels and reveal risks that lead to heart attacks and strokes, said Dr. Laurie Margolies, an associate professor of radiology, and Dr. Harvey Hecht, a professor of medicine at Mount Sinaiís Icahn School of Medicine.

The physicians expect their proposal to stir debate when they present it this week at a meeting of the American College of Cardiology in Chicago.

"Historically, when reading mammograms we were taught that we have one job and one job only, and thatís to look for cancer," said Margolies, chief of breast imaging at Mount Sinai Hospitalís Dubin Breast Center. "But mammography is designed to reveal calcifications in the breast because calcifications can be an early sign of breast cancer."

Though calcium deposits in breast tissue are important in the diagnosis of cancer, blood vessels that branch throughout the breast can independently possess calcifications. Those deposits, Margolies said, are a salient signature of atherosclerosis, the narrowing of vessels marred by plaque.

Based on the new research involving nearly 300 women, Margolies said it is very likely that a patient may have no evidence of calcification associated with cancer, but may have obvious deposits in the branching arteries ó blood vessels in the breast ó suggestive of a risk for heart disease.

"The calcifications that are in the vessels look very different from cancer calcifications," Margolies said. She noted that calcifications in the vasculature show up sharp on digital mammograms just as tissue calcifications are clear in an image suggestive of cancer.

Hecht, director of cardiovascular imaging at Mount Sinaiís St. Lukeís Hospital, also in Manhattan, said the new research is the first relatively large study to determine whether mammography is a useful tool to screen for a major cardiovascular risk factor.

Earlier, smaller research projects, he said, also examined mammography to screen for heart disease, but they didnít fully explore the degree to which the technology could be an appropriate tool.

The new analysis, Hecht added, is the first to show breast arterial calcification correlating with coronary artery calcification because in the study, women who had signs of arterial calcium deposits on a mammogram were confirmed through CT scans to have evidence of coronary artery deposits as well.

Moreover, Hecht said, the mammogram evidence turned out to be a more powerful predictor of heart disease risk than other well-established cardiovascular indicators such as high cholesterol, high blood pressure and diabetes.

"It takes less than 15 seconds to analyze," Hecht said of spotting arterial calcium deposits on a mammogram.

Dr. Stacey Rosen, vice president of womenís health at The Katz Institute for Womenís Health, a division of medical-care giant Northwell in New Hyde Park, said sheís excited about the new findings and plans to be in the audience a week from Saturday when Margolies and Hecht officially announce their findings.

"I think itís fascinating from a couple of points of view," Rosen, a cardiologist, said Wednesday, noting that the research is important because it means an existing technology may be used to help combat the biggest disease threat women face.

"This is also an opportunity to align different clinical groups to really look at womenís health needs in total. This presents an opportunity for practitioners to get out of their silos," Rosen said.

She emphasized that the work is still preliminary and needs to be replicated, but with solid science already undergirding the findings, Rosen said itís likely future research will support the notion that mammograms can be used to screen for signs of heart disease.

Margolies, meanwhile, said a single mammogram can yield results about cancer and heart disease at the same time.

"With no additional cost or radiation exposure, women can get this information through routine mammography," she said.

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