A welcome from Paula Schneider, CEO of InAWH
Dear friends,
Welcome to Ask. Know. Act., the InAWH newsletter. Whether you joined us at our inaugural convening in New York on Oct. 9, watched it on our YouTube channel, or are just finding us now, you are part of this community, and we are glad you are here.
InAWH exists because of a gap. The science on women’s midlife health exists. The system to deliver it is broken. We are working to close the gap between what is known and what’s done in women’s midlife health care, through education for women and clinicians and a community that moves the work and systems, forward together.
Each month we will share news from our work and three ways you can take part. Then, tell us what you want us to take on next. (Reply to this email and a live person will read it.)
Read on for news about our first gap-closing initiative: Developing a clinical protocol for breast arterial calcification (BAC) reporting on routine mammograms. Cardiovascular disease kills more women than all cancers combined, and a warning sign is already sitting on many routine mammograms. Breast arterial calcification (BAC) is calcium in the walls of the breast arteries that shows up on the image and signals cardiovascular risk. In the MINERVA study of 5,059 postmenopausal women followed for about six and a half years, those with BAC had a 51% higher risk of a heart attack, stroke or other cardiovascular event. About 40 million mammograms are performed in the United States each year, and BAC is present in an estimated 12 to 30% of women who are screened, so roughly 5 to 12 million of those mammograms could show it. That makes the mammogram a twofer: the same image that screens for breast cancer can also flag heart risk, with no extra scan, radiation or cost.
Looking forward to advancing women’s health together.
Warmly,
Paula Schneider
CEO
News and updates
The convening, in brief
On Oct. 9, about 150 guests filled the Yale Club for InAWH’s inaugural convening, a day of women’s midlife health in the spotlight. We had amazing speakers and panelists. Please watch the day here.
A few highlights:
If you watch one talk to understand BAC, watch Dr. Erica Spatz, a preventive cardiologist at Yale. She explained why breast arterial calcification (BAC) is a cardiac health risk marker rather than a diagnosis, and why the field still lacks a guideline for it and why it is important for you to know about it.
Dr. John Eden’s compelling talk “what every man should know about menopause” shared the compared research funding in the U.S. to Australia’s efforts.
Dr. Pauline Maki described groundbreaking legislation in Illinois, and how Maryland’s patient notification rule for BAC, in effect since Oct. 1, served as a model for other states.
The talks spurred real-time action: Conversations that began during the sessions have already pointed toward inquiries from multiple leading institutions and media coverage of the event in AuntMinnie.com prompted further outreach about coordinating efforts. 23andMe included info about BAC in their National Mammogram Day materials.
Weren’t there? Every talk is on our YouTube playlist.
BAC: momentum across world class organizations
InAWH and the Washington Research Foundation are working to standardize how BAC is identified, reported, and followed up. Foundation CEO Orin Levine told Forbes the plan is to “put those protocols and pathways to work” over three years and study the effect on women’s heart health.
In the days since the convening, three other world class organizations have connected with us about reporting and research, and Yale is preparing to add BAC to its mammogram reports. We are excited to keep up the momentum.
In the news
Forbes: “Mammograms Can Reveal Heart Risk, But Few Women Are Ever Told.” Geri Stengel on the launch and the case for reporting BAC.
AuntMinnie: “New research initiative to create protocol for women with BAC.” Coverage for the radiologists who decide what goes in a report.
Ask. Know. Act.
Three ways to take part.
Ask. Ask for a BAC reading
At your next mammogram, ask whether BAC (breast arterial calcification) was visible. No extra imaging is needed. If it was seen, it is a risk marker, not a diagnosis, so talk with your clinician about it in the context of your overall heart risk.
Most doctors do not report BAC yet, so you may hear it is not available. If so, ask your primary care provider or gynecologist whether the radiologist can take a second look at your images. One of our own team asked at check-in on Oct. 16 and was told only one radiology group in her area reports it. That is the gap.
Know. Get radiologists and cardiologists talking
Radiologists see BAC on the images. Cardiologists and primary care clinicians know how to assess heart risk. Start the conversation in your own system: ask your breast imaging team whether BAC appears in reports and who would receive the finding.
The American College of Cardiology’s Cardiology magazine reports that BAC was most predictive of heart disease and death in women younger than 60, and that no U.S. or international guideline covers reporting yet.
Act. Take it to your legislators
Reporting rules are set state by state. Maryland is the only state that requires breast imaging centers to notify patients of BAC findings. Ask your state legislators whether patients in your state will be told when BAC appears on their mammogram.
