New heart procedure safer for women

Women with a family history of heart disease or other heart disease risk factors should schedule a doctor’s appointment for their annual heart checkup.

Surgeon Inserting Tube Into Patient During Surgery
Radial artery catheterization involves placing a small tube near the thumb side of the wrist. Using X-ray, the physician guides the catheter up to the shoulder and then down to the heart through the radial artery.

At the checkup, some physicians might recommend further testing to rule out or confirm a diagnosis. In the cases where a heart procedure such as a cardiac catheterization is required, women should ask their physicians about using a radial artery approach.

Standard heart catheterization involves inserting a catheter into the femoral artery in the groin and threading it to the heart to perform a variety of tasks, such as measuring the heart, diagnosing conditions, clearing a blockage or placing a stent. A new technique, called a transradial catheterization, inserts the catheter into the radial artery at the wrist.

“The radial artery approach is much safer for women,” said Colin Barker, M.D., cardiologist at the Houston Methodist DeBakey Heart & Vascular Center. “A recent clinical trial of more than 1,700 catheterizations in women showed the rates of bleeding or vascular complications were 59 percent lower when using the radial artery approach.”

The catheterization begins when a small tube is placed in the radial artery, which is located on the thumb side of the wrist. Using X-ray, the physician guides the catheter up to the shoulder and then down to the heart through the radial artery.

Barker says the radial artery catheterization is safer because the radial artery is located closer to the skin’s surface, which allows bleeding complications to be spotted sooner. It is also more comfortable for patients. The femoral approach requires patients to lay flat for four to six hours after the procedure, while radial artery catheterization patients are sitting up and getting out of bed within minutes.

Barker noted the radial artery catheterization is used in approximately five percent of cases in Houston and less than 20 percent of cases in the United States.

Transradial catheterization has a 59% lower risk of complications compared to standard heart catheterization Click To Tweet

Barker said the radial artery catheterization is used in 60 to 80 percent of cases outside the U.S. and has become standard medical practice in Europe. He added that it is not being used as often in the United States because it’s a difficult technique that is tedious to learn. More than 80 percent of patients surveyed prefer the radial artery approach, so Barker believes patient preference will help drive up the use of the procedure.

“I’ve seen the benefits it provides my patients, especially women,” Barker said. “I hope the technique becomes more widely available as doctors and hospitals continue to gain experience and proficiency in the procedure.”

Genetic mutations: knowing your cancer risk

Just a few decades ago, mothers would have considered certain topics off limits when talking with their daughters.  Today, these kinds of conversations are less taboo, especially when it comes to talking about family medical history. Take time to ask about your family’s medical history, especially for breast and ovarian cancers.

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Mutations can be inherited from either parent and may be passed on. Each child of a genetic carrier has a 50 percent chance of inheriting the mutated gene.

Your family’s health history may mirror your own and give you a heads up on what you to expect. For example, the likelihood of developing common gynecological conditions such as endometriosis and polycystic ovary syndrome greatly increase if a close female relative, such as your mother or aunt, has a history of the condition. Tejal Patel, M.D., leads the high-risk clinic at Houston Methodist Cancer Center and says mothers can influence their daughters screening choices across their life span.

When cancer is present in a family, genetic counselors play a prominent role in helping families understand their risk.  Many of us have heard about BRCA gene mutations that can produce hereditary breast-ovarian cancer syndrome in affected families. Patel says mutations in BRCA1 and BRCA2 genes account for only five to 10 percent of all breast cancer cases in women, but the goal is to find the mutation in women before they develop cancer. Patients with either BRCA mutation have a 55 to 87 percent higher lifetime risk of developing breast cancer of (compared to a general population risk of 10 to 12 percent), as well as a 20 to 40 percent higher lifetime risk of developing ovarian cancer (compared to a general population risk of less than two percent).

“High-profile figures, like actress Angelina Jolie, have brought this topic to the forefront. Now it is up to all women to continue to increase awareness,” says Patel.

Patel stresses that a simple blood or saliva test can tell a woman whether she’s at a higher risk of developing breast or ovarian cancer.  In some cases, a woman with a negative genetic test may still be considered to be at an increased risk of developing breast cancer.  There are other gene mutations (besides BRCA 1 and 2) that may also increase a woman’s risk of developing cancer.  Knowing the risk can help both the patient and the doctor make more informed decisions about a health plan before cancer has a chance to develop.

Patients with BRCA mutations have a 55% to 87% higher lifetime risk of developing breast cancer Click To Tweet

Women should talk with their physicians about testing for hereditary breast and ovarian cancer syndrome if they have personal or family history of the following:

  • Breast cancer at age 50 or younger
  • Ovarian cancer at any age
  • Male breast cancer at any age
  • Ashkenazi Jewish ancestry and a personal or family history of breast or ovarian cancer
  • Two breast cancers in the same person or on the same side of the family
  • Triple negative breast cancer at age 60 or younger
  • A previously identified BRCA1 or BRCA2 mutation in the family

Mutations can be inherited from either parent and may be passed on to both sons and daughters. Each child of a genetic carrier, regardless of sex, has a 50 percent chance of inheriting the mutated gene from the parent who carries the mutation. That means half of the people with BRCA gene mutations are male.

Patel says men should consider testing if they have a personal history of breast cancer, a family history of breast or ovarian cancer, or a family member with a BRCA1 and BRCA2 mutation. Although male breast cancer is rare, men who carry BRCA mutations are more likely to develop breast cancer and prostate cancer.