Nancy Preston did not have a heart attack. She also did not have chest discomfort, shortness of breath or rapid heartbeat, all symptoms of heart disease. Instead, routine mammograms led to Preston having a quintuple bypass last summer.
“We were just expecting something terrible,” said the 67-year-old man from New York. “I had no symptoms other than feeling more tired than usual, which I attributed to age.”
Preston does have a family history of cardiovascular disease. Her mother had a heart attack and had double bypass surgery, and her older sister had a heart attack and was given a pacemaker.
Despite this, heart disease wasn't the focus of Preston, a yoga enthusiast who trained daily and maintained a healthy diet. Her high blood pressure And type 2 diabetes She said two conditions that can increase the likelihood of developing heart disease were under control before she began to worry about her health.
In October 2024, Preston had her annual mammogram at Mount Sinai Health System in New York City. Doctors found breast artery calcification (MAC) on Preston's mammogram.
What is breast artery calcification?
Breast artery calcifications are accumulations of calcium in the arteries of the breast and may be associated with heart disease. Mount Sinai is conducting behavioral research To understand how women respond to notification of arterial calcification in mammography results.
After Preston, a study participant, was notified of breast artery calcification, she underwent a cardiac exercise test, which monitors heart function during exercise.
“IN [Preston’s] In this case, her heart function was very strong at rest, but during the stress phase, part of her heart muscle did not contract properly, said Dr. Mary Ann McLaughlin, a cardiologist at Mount Sinai Faster Heart Hospital. “Her results showed multivessel coronary heart disease.”
McLaughlin and Preston believe the BAC findings saved her life.
“The only reason Nancy took the stress test was because she was a study participant,” McLaughlin said. “If she had come to me with what she had, which was well-controlled risk factors and no symptoms, I most likely would not have referred her for a stress test.”
Preston continues to recover from major surgery she underwent in July. “Thank God this BAC was shared with me,” she said.
The U.S. Preventive Services Task Force recommends that women ages 40 to 74 get mammograms every two years to screen for breast cancer. Although federal law requires that certain information, such as breast densityto be included in mammogram reports, health care providers do not need to mention breast artery calcification.
Dr. Laurie Margolis, director of breast imaging at Mount Sinai's Dubin Breast Cancer Center and the study's leader, hopes to change that.
“In more than 10% of mammograms you will see calcified arteries, and people are always surprised,” said Margolis, who has studied the relationship between Breast artery calcification and heart disease about ten years. “When arteries become calcified in a woman's breast, it is logical to assume that the vessels may be calcified elsewhere.”
Mammary artery calcifications specific to breast arteries are different from calcifications specific to other areas of the breast. Macrocalcifications, which appear as white spots on a mammogram, are usually benign, according to the National Cancer Institute. Microcalcifications appear as white spots and in some cases may indicate cancer. About half of women develop benign breast calcification.
The Mount Sinai study, which began enrolling patients aged 40 years and older in 2021, aims to analyze BAC levels in a diverse sample of 14,875 women. Margolis estimates that 12.5% of women in the healthcare system have breast artery calcification, including women with known heart disease.
In the second part of the study, 1888 patients with breast artery calcifications were randomly divided into two groups. Women in the first group are notified of the results, informed about the risk of cardiovascular disease and recommended to consult with a preventive cardiologist. Women in the second group receive a standard mammogram letter and are notified six months later of their BAC reading.
Results are expected in early 2027.
How breast screening helps detect heart disease
2018 review published in the magazine Journal of Cardiovascular Imaging advocated mammography as a screening tool for cardiovascular disease. 2022 study published in the journal Circulation: Cardiovascular Imaging found a link between calcification of breast arteries and cardiovascular disease. postmenopausal women between the ages of 60 and 79, and a 2024 study published in the journal JACC: Achievements noted that BAC is “particularly predictive” of cardiovascular disease in young women aged 40 to 59 years.
Dr. Naomi Ko, chief of breast medical oncology at NYU Langone Health, said the Mount Sinai study adds to a growing body of evidence that the hallmarks of cardiovascular disease reside in the breast.
In some cases, women can improve their heart health by making behavioral changes and taking medications to prevent more serious medical intervention.
“Give me the opportunity to advise my patients to make better lifestyle choices, and I will take it,” said Ko, who is not involved in the study. “If it causes and influences improved health behaviors and positive engagement in your healthcare, that's great.”
This is a promising link between breast artery calcification, also called vascular calcification, and heart disease.
“It's not a slam dunk,” Ko said. More research is needed and women should not panic if they find out they have BAC.
“We know that these calcifications are associated with cardiovascular problems, but we are not 100% sure what this might mean for each individual patient,” Ko said. “It’s one data point about your body.”
Mammogram results should prompt discussions about a patient's heart and breast health, said Dr. Melanie Chellman, a breast radiologist at the Cleveland Clinic who was not involved in the study.
“The great thing about mammograms is that we already do them on specific women who are at the highest risk for heart disease: those 40 years of age and older,” Chellman said. “We can use the same images to look for vascular calcifications.”
Dr. Steven Isacoff, chief clinical officer of breast oncology at the Massachusetts Brigham Cancer Institute, said educating health care providers is as big an obstacle as educating patients.
“Most of my colleagues, I bet, don’t know about the connection between breast artery calcifications [and heart disease]”,” said Isakov, who was not involved in the study. “I think that without more specific guidance in the report on what steps should be taken, this may not be accomplished.”
More research is needed to determine the extent to which arterial calcification in the chest is a concern, he said. Meanwhile, he praised Mount Sinai's efforts to fill data gaps.
“There’s a lot of information hidden in mammograms,” Isakov said.
