Canadian Society of Breast Imaging Position Statement on Breast Arterial Calcification Reporting on Mammography

Although cardiovascular disease is the leading cause of premature death in Canadian women, 1 most women are unaware of their personal cardiovascular risk status.2 Breast arterial calcification (BAC) has been identified as an independent cardiovascular risk factor 3-8 and is strongly correlated with cardiovascular risk. 9 

BAC is often seen on mammography (12-42.5% of women undergoing screening mammography) 4-10 but is not routinely documented in the mammography report. The reporting of BAC on screening and diagnostic mammography could be as valuable for cardiovascular risk stratification as coronary arterial calcium (CAC) score on computed tomography (CT).11-12 Detection of BAC on mammography could allow intervention in asymptomatic women at higher cardiovascular risk. 3,13 

Canadian radiologists do not routinely report BAC on mammography. Our cardiac colleagues have noted a discrepancy in reporting of BAC in Canada compared to other countries. 9,14 Reporting breast arterial calcification is an opportunity to improve awareness of a woman’s cardiovascular risk status. 15 

The Canadian Society of Breast Imaging (CSBI) proposes using the following grading system for BAC: 

Grading of Breast Arterial Calcifications: 16

Grade 0: No vascular calcification 

Grade 1: Few punctate vascular calcifications without coarse, tram-track, or ring calcifications

Grade 2: Coarse vascular calcification or tram-track calcification in fewer than 3 vessels

Grade 3: Severe coarse vascular or tram track calcification affecting 3 or more vessels 

When mammography identifies grade 3 BAC, CSBI proposes including the following script in the mammogram report. Reporting lower grades in patients under 55y could be considered. 

There are severe coarse vascular or tram track calcifications affecting 3 or more vessels in the breasts (Grade 3). A strong association between breast arterial calcifications and cardiovascular disease has been identified in multiple studies. Consider correlation with cardiovascular risk factors as clinically indicated. 

Position Statements

Canadian Society of Breast Imaging’s Position Statement on Breast Arterial Calcification Reporting on Mammography


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10.1016/S0140-6736(17)32152-9. Erratum in: Lancet. 2017 Oct 28;390(10106):e38. PMID: 28919116; PMCID: PMC5605883. 

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8. Yoon YE, Kim KM, Lee W, Han JS, Chun EJ, Ahn S, et al. Breast Arterial Calcification is Associated with the Progression of Coronary Atherosclerosis in Asymptomatic Women: A Preliminary Retrospective Cohort Study. Sci Rep. 2020;10(1):2755. 

9. Iribarren C, Chandra M, Lee C, Sanchez G, Sam DL, Azamian FF, et al. Breast Arterial Calcification: a Novel Cardiovascular Risk Enhancer Among Postmenopausal Women. Circ Cardiovasc Imaging. 2022;15(3):e013526. 

10. Margolies L, Salvatore M, Hecht HS, Kotkin S, Yip R, Baber U, et al. Digital Mammography and Screening for Coronary Artery Disease. JACC Cardiovasc Imaging. 2016;9(4):350-60.

11. Kavousi M, Desai CS, Ayers C, Blumenthal RS, Budoff MJ, Mahabadi AA, et al. Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk Women: A Meta-analysis. Jama. 2016;316(20):2126-34. 

12. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-e143. 

13. Canadian Partnership Against Cancer. Breast Cancer Screening in Canada: Monitoring and Evaluation of Quality Indicators – Results Report, January 2011 to December 2012. Toronto: Canadian Partnership Against Cancer; 2017. Available at Accessed on (08/15/22) 

14. Trimboli RM, Capra D, Codari M, Cozzi A, Di Leo G, Sardanelli F. Breast arterial calcifications as a biomarker of cardiovascular risk: radiologists’ awareness, reporting, and action. A survey among the EUSOBI members. European radiology. 2021;31(2):958-66. 

15. Brown AL, Wahab RA, Zhang B, Smetherman DH, Mahoney MC. Reporting and Perceptions of Breast Arterial Calcification on Mammography: A Survey of ACR Radiologists. Acad Radiol. 2022;29 Suppl 1:S192-s8. 

16. Heaney RM, Zaki-Metias KM, McKee H, Wang H, Ogunde B, Yong-Hing CJ, Freitas V, Ghai S, Seely JM, Nguyen ET. Correlation Between Breast Arterial Calcifications and Higher Cardiovascular Risk: Awareness and Attitudes Amongst Canadian Radiologists Who Report Mammography. Can Assoc Radiol J. 2022 Dec 21:8465371221140347. doi: 10.1177/08465371221140347. Epub ahead of print. PMID: 36541871.

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