How a mammogram could help Marylanders prevent a heart attack

Marylanders will now get more from their annual mammogram than a breast cancer screening.

A first-in-the-nation law went into effect this month that requires patients to be notified if their scans show breast arterial calcification. If there is calcium buildup in vessels in the breast, that could tell doctors a lot about that person’s risk of heart disease.

“Knowledge is power,” House Speaker Joseline Peña-Melnyk, the bill’s sponsor, said earlier this year before the bill’s passage.

Cardiovascular disease kills more women than all forms of cancer combined, but it often goes undiagnosed. The legislation aims to prompt more patients to talk to their doctors about their risk before a major cardiac event like a heart attack.

Mammograms identify masses that may turn out to be cancerous, but they also reveal calcification in the breast arteries, which appears as little white lines.

The information readily available on the images hasn’t always been shared with patients or even the referring doctors. The new Maryland law requires the findings to be sent in letters to patients as part of their breast cancer screening results.

That requirement — whether the deposits are present or not — drew concern from some doctors who said it was premature, potentially causing confusion and alarm.

Two leading breast imaging experts at Johns Hopkins Medicine, Drs. Emily Ambinder and Pouneh Razavi, opposed the bill, writing in testimony earlier this year that their position “reflects our commitment to evidence-based medicine and to protecting the integrity of mammography as a primary breast cancer detection tool.”

They said there aren’t yet established follow-up steps for when breast arterial calcification is found, like there are for masses and other types of calcification linked to breast cancer.

There also isn’t a clear threshold for when interventions should be recommended.

Nevertheless, heart disease is such a worry that sharing the information is widely supported by leading medical groups, including MedChi — the state’s largest physician association — and the Maryland chapter of the American College of Obstetricians and Gynecologists.

Those groups said patients typically begin having mammograms age 40 and that the notification could alert patients to cardiovascular risk well before a heart attack, stroke or heart failure.

“Too often, women leave a screening unaware that the same image may reveal information that could prompt actionable lifesaving information such as lifestyle changes, cholesterol-lowering medication or other imaging to further evaluate cardiovascular risk,” said Dr. Rachel Brem, co-founder and chief medical officer of Brem Foundation to Defeat Breast Cancer and a professor of radiology at George Washington University.

She said there “is work to do” in informing doctors and patients about the new law, but that’s not a good reason to withhold information.

Brem said other states may soon follow Maryland’s lead and eventually there could be a federal mandate.

Dr. Michael Coords, medical director of cardiovascular imaging at RadNet, which operates dozens of outpatient imaging centers in Maryland, said getting calcification results more uniformly to patients is a good idea.

The centers have been preparing for months, training staff, developing handouts for doctors and establishing their own standards. They will use FDA-approved AI technology to better identify the calcifications. There won’t be any extra images or costs, he said.

Coords said the deposits should be considered another risk factor in overall assessments.

“Maybe the verbiage in the letter will cause some anxiety, but we think this will be very helpful and save lives,” he said. “It’s very, very important.”