Radiologists must work to standardize breast calcification reporting or advocates may intervene

Few radiologists consistently include breast arterial calcification findings in their mammography reports, according to evidence published Wednesday. And for providers who do indicate BACs, nearly two-thirds make no follow-up recommendations.

The findings come by way of the American College of Radiology, which surveyed nearly 600 of its members this past September.

Many studies have proven breast calcium deposits are associated with cardiovascular disease and coronary artery calcification, researchers explained Feb. 17 in Academic Radiology. Yet only 41% of respondents said they report BAC "always" or "most of the time."

More standardized techniques will be needed in clinical practice to bolster these rates, according to Ann L. Brown, MD, with the University of Cincinnati Medical Center, and colleagues.

“Although we acknowledge that there is no consistent management approach to BAC seen on mammography, we believe that more consistent reporting…will ultimately encourage the development of clinical guidelines,” Brown et al. explained in the study. “Implementation of a template containing BAC can be the first step to changing radiologists’ reporting practices.”

In an effort to gauge such practices and perceptions on the topic, the authors emailed ACR members an 18-question survey, gathering 598 responses.

Overall, up to 87% claimed to include calcifications in their breast imaging reports. And when BAC is documented, 69% only record its presence, while 23% offer a subjective grade, and 1% calculate a BAC score. More experienced rads were more likely to report such findings and agree that BAC is a cardiovascular risk factor.

Furthermore, among those reporting BAC, 58% make no subsequent recommendations, while the remainder recommend primary care follow-up (39%), cardiology evaluation (13%), and/or coronary calcium scoring CT (11%).

Brown et al. compared the ongoing state of calcification reporting to breast density reporting prior to current breast density legislation. Before 2009, dense breast data wasn’t routinely conveyed to patients until advocacy efforts changed the paradigm. The same may happen for BAC reporting, the authors explained and added that upcoming info-blocking rules may also propel a national movement to enhance personal health information access.

“The reporting of BAC is proactive in the absence of guidelines and has potential to mitigate risk not only for patients, but for radiologists and referring providers as well,” the team wrote. “Unless the breast imaging community takes a proactive approach, advocates of BAC reporting may take steps to enact similar notification laws for BAC on mammography,” they added later.

Read the entire study here.