July 12, 2006 Women and Heart Disease According to the American Heart Association, about 6 million women in the U.S. have coronary heart disease. Its usually caused by a build-up of fatty deposits and plaque along portions of the inner walls of the coronary arteries. Eventually, a portion of the affected artery can become clogged by a blood clot or plaque build-up. When that happens, blood flow through the artery is impeded or blocked. The part of the heart muscle fed by that artery is deprived of oxygen and dies. This is a heart attack, or myocardial infarction. Heart disease is the leading killer of women. In 2003, 233,900 women died from coronary heart disease and 81,300 died from a heart attack. The average age at the time of first heart attack for females is about 70.4. Of those who survive a heart attack, 38 percent will die within one year. Screening Mammograms for Women Screening mammography is a diagnostic technique that uses low doses of X-rays to examine breast tissue for abnormalities. Health experts recommend an annual screening mammogram for women 40 and older. The National Center for Health Statistics reports 70 percent of American women 40 and older have had a mammogram within the past two years. Mammograms can detect very small breast tumors that cant be detected on a physical exam, allowing women to get earlier treatment. According to the organization, breastcancer.org, regular mammograms can reduce the chance of dying from breast cancer by 35 percent. The Mammogram/Heart Connection Mammograms show changes in the soft tissues of the breast. But they can show other changes as well. X-rays dont easily pass through dense areas, including build-up of calcifications in the breast arteries. Thus, breast arterial calcification can often be seen on the mammogram image. Research shows the frequency of breast arterial calcification increases with age and is especially common after menopause. Barbara Jaeger, M.D., a Diagnostic Radiologist at Mercy Medical Center in Baltimore, says the arterial calcification that is seen on a mammogram may also be occurring in the arteries of the heart. Some studies suggest breast arterial calcification appears to be associated with an increased risk for death from overall causes, especially for women with diabetes. Other studies have not found a definite link between the arterial calcifications in the breast and angiographic evidence of coronary artery disease. The American Heart Association estimates 64 percent of women who die suddenly from coronary heart disease have no previous symptoms of the condition. Thus, while the precise connection between calcification in the breast arteries and coronary artery disease may not yet be clear, mammograms may still serve as a warning sign of risk for heart disease. At Mercy Medical Center doctors have developed a program to flag women who show signs of breast arterial calcification. The affected patients are sent a letter recommending referral to an internist or cardiologist for follow-up and testing for coronary artery disease. AUDIENCE INQUIRY For general information on mammography or breast cancer: Breastcancer.org, http://www.breastcancer.org Centers for Disease Control and Prevention, http://www.cdc.gov National Cancer Institute, http://www.cancer.gov Radiological Society of North America, public website, http://www.radiologyinfo.org For information on heart disease: American Heart Association, http://www.americanheart.org, or contact your local chapter BIBLIOGRAPHY "Breast Cancer and Mammography Information," Atlanta: Centers for Disease Control and Prevention, downloaded from website (http://www.cdc.gov), May 31, 2006. Cetin, M., et al., "Breast Arterial Calcifications Associated with Diabetes and Hypertension," Journal of Diabetes Complications, November-December 2004, Vol. 18, No. 6, pp. 363-366. Cetin, M., "Prevalence of Breast Arterial Calcification in Hypertensive Patients," Clinical Radiology, January 2004, Vol. 59, No. 1, pp. 92-95. "Facts About Women and Cardiovascular Diseases," Dallas: American Heart Association, downloaded from website (http://www.americanheart.org), June 7, 2006. Henkin, Y., et al., "Lack of Association Between Breast Artery Calcification Seen on Mammography and Coronary Artery Disease on Angiography," Journal of Medical Screening, 2003, Vol. 10, No. 3, pp. 139-142. Kappadath, S., and C. Shaw, "Dual-Energy Digital Mammography for Calcification Imaging," Medical Physics, November 2005, Vol. 32, No. 11, pp. 3395-3408. Kemmeren, Jeanet, et al., "Arterial Calcification Found on Breast Cancer Screening Mammograms and Cardiovascular Mortality in Women," American Journal of Epidemiology, February 15, 1998, Vol. 147, No. 4, pp. 333-341. "Mammography," Hyattsville: National Center for Health Statistics, downloaded from website (http://www.cdc.gov), May 31, 2006. "Mammography," Oak Brook: Radiological Society of North America, downloaded from public website (http://www.radiologyinfo.org), May 31, 2006. Markopoulos, C., et al., "Breast Arterial Calcifications as an Indicator of Systemic Vascular Disease," Acta Radiologica, November 2004, Vol. 45, No. 7, pp. 726-729. Moshyedi, Arman, M.D., et al., "Breast Arterial Calcification," Radiology, January 1995, Vol. 194, No. 1, pp. 181-183. Reddy, J., et al., "Prevalence of Breast Arterial Calcifications in an Ethnically Diverse Population of Women," Annals of Epidemiology, May 2005, Vol. 15, No. 5, pp. 344-350. "Screening Mammograms," Bethesda: National Cancer Institute, downloaded from website (http://www.cancer.gov), May 31, 2006. Van Noord, P., et al., "Mammograms May Convey More than Breast Cancer Risk," European Journal of Cancer Prevention, December 1996, Vol. 5, No. 6, pp. 483-487. "Women, Heart Disease and Stroke," Dallas: American Heart Association, downloaded from website (http://www.americanheart.org), June 7, 2006.