MICHEL MARTIN, HOST:
October is Breast Cancer Awareness Month, which comes with reminders for annual mammograms. You might've heard one of these. One state is now requiring radiologists to tell patients whether their screenings for breast cancer reveal a warning sign for heart disease. That warning sign is called arterial calcification. Dr. Lisa Mullen is here to help explain that. She is an associate professor of radiology at Johns Hopkins University who helped revise the draft of the new legal requirement that's now in effect in Maryland. Dr. Mullen, good morning. Thanks for joining us.
LISA MULLEN: Oh, thank you for having me.
MARTIN: So what is breast arterial calcification, and what can it tell you about someone's health?
MULLEN: So breast arterial calcifications are basically calcifications - so that sort of white mineral - deposited in the wall of arteries in the breast - or, you know, we're seeing it in the breast. And since calcifications appear white on a mammogram, they are visible to radiologists, and they can be distinguished from other types of calcifications that occur commonly in the breast tissue. And it's important to know that arterial calcifications are not related to breast cancer or breast cancer risk. So they're not a marker of breast cancer, but they are potentially a marker of other cardiovascular disease.
MARTIN: OK. So it's a side benefit of getting that mammogram, right? The initial - the point of the mammogram is the breast cancer, but then you get this other benefit for some sort of indication. But what should...
MULLEN: Yes.
MARTIN: ...Clinicians and patients do if this calcification is detected?
MULLEN: So, you know, what we're - well, just to backtrack a little bit, the new law in Maryland is requiring radiologists to report breast arterial calcifications if they're present on a mammogram. So this really only applies to mammograms. And then the law also provides some required language that has been added to patient result letters. So the lay letter that the patient gets when they have a screening mammogram or a diagnostic mammogram will have some information about breast arterial calcifications, along with information that the patient does or does not have breast arterial calcifications themselves. But then there's some general information as well.
So that paragraph suggests that if these calcifications are present, that the patient should speak to her primary care provider about her cardiovascular risk. So that would be the first step, just talking to the patient's provider. You know, so the woman talks to her provider about her cardiovascular risk. And maybe together, they can discuss whether a more formal risk assessment needs to be performed for that patient, and that could be very individual, depending on the patient and her own risks.
MARTIN: Well, to that end, you know, two other breast radiologists at Johns Hopkins opposed this law in part because they said there's not a standard step for how to follow up. And they said that that just creates more anxiety for patients. So what's your take on this? Why do you think this is still, you know, a positive step to require this notification?
MULLEN: Well, I think one of the challenges that's faced with this is that radiologists were reporting it, but it was kind of optional. So there's no national guideline about reporting this and no agreement about whether it should be reported or how it should be reported or what should be done if calcifications are found. And I think the legislation in Maryland, which is mandating reporting - and it really is a binary reporting, so basically, you know, yes or no, present or not present. So we're not really looking at the grade, the amount of calcification or the number of arteries that are calcified. So it's not really quantified, but it's more just yes or no, you have it or you don't. And I think the - you know, the opposition comes from all of these uncertainties that we're not really sure what the best evaluation would be if this is detected, you know, or what it ultimately means for the patient.
MARTIN: So I think the point is that then this is something you should then follow up and talk to your doctor about.
MULLEN: Yes, correct.
MARTIN: That is Dr. Lisa Mullen at Johns Hopkins University. Thank you so much.
MULLEN: Thank you, Michel.
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