Background/Purpose: Systemic Sclerosis is an autoimmune disorder marked by thickened and hardened skin. Cutaneous cutis, the deposition of insoluble calcium salts in the skin and subcutaneous tissues, occurs frequently in patients with systemic sclerosis. Breast mammography is a screening tool used to detect breast cancer. Approximately 10% of all patients have abnormal mammograms with areas of calcification, which may be a sign of malignancy. There has been no formal study to date evaluating the mammograms of patients with systemic sclerosis. This study compared the mammograms and breast biopsies of systemic sclerosis patients with that of age matched controls.

Methods: Patients diagnosed with systemic sclerosis and with mammograms done at Mount Sinai Hospital between 01/01/2017 and 01/11/2022 were identified using the Reports function in Epic. The results of these mammograms and subsequent breast biopsy results were analyzed. Participants’ race/ethnicity, serologic markers, clinical features, use of immunosuppressive medications, and duration of systemic sclerosis diagnosis were determined by chart review. These results were compared to age matched controls with abnormal mammograms and breast biopsies. The primary outcome was the frequency of false positive abnormal mammography findings. Sub-analysis was performed among the patients with systemic sclerosis comparing patients with malignancy found on breast biopsy to those with benign findings. Chi Square analysis and Independent Sample T test were used to check for statistical significance.

Results: Of the patients with systemic sclerosis, more than a third of these patients (36%) were found to have had calcifications on their mammograms. 29/152 (19%) were found to have abnormal breast mammograms and were referred for breast biopsy. Of these patients, 34.5% were diagnosed with a malignancy after completing their breast biopsy. 65.5% of the scleroderma patients were found to have false positive screening mammograms versus 67% of the age-matched control group. Sub-analysis within the scleroderma cohort found no statistically significant differences in serologic markers or clinical features amongst patients with breast cancer compared to those without breast cancer. Of the systemic sclerosis patients found to have had true malignancies, only 1 (10%) was taking hydroxychloroquine, while 10 (52.6%) of patients with false positive mammograms were taking hydroxychloroquine. There were no other statistically-significant differences in terms of medication usage.

Conclusion: Approximately 1/5th of patients with systemic sclerosis were found to have abnormal breast mammograms. There were no significant differences in the rate of false positive mammograms in patients with systemic sclerosis and healthy controls.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-systemic-sclerosis-affect-the-interpretation-of-mammograms-a-retrospective-cohort-study/