Life, Life, Life: Check it out

Since Angelina Jolie went public with her preventive double mastectomy and oophorectomy, referrals for BRCA tests have spiked all over the world.

January 26, 2017 13:44
4 minute read.
Topless model

Topless model (illustrative). (photo credit: ING IMAGE/ASAP)

I’m not an uber-fan of Angelina Jolie’s movies; for me she’s an okay actress with a silkily sexy body, not to mention a super-gorgeous ex-husband. But even though I’m not convinced she is the most beautiful woman alive, Jolie is a true hero. Since she went public with her preventive double mastectomy and oophorectomy, referrals for BRCA tests have spiked all over the world.

The BRCA gene, named (depending on whom you ask) either for UC Berkeley, California, where it was discovered in 1990 by Prof. Mary-Claire King, or for BReast CAncer, is a human caretaker gene (a.k.a. a tumor suppressor) that produces a protein that repairs DNA. In normal cells, BRCA1 and BRCA2 ensure the stability of genetic material (DNA), preventing uncontrolled cell growth. But a damaged gene can’t stop cancer from doing what cancer does best: rampaging through the body.

Jolie, like one in 800 people in the general population, carries the BRCA1 gene mutation. Carriers, obviously, do not all have sculpted cheekbones and seductively smoldering eyes; there is no outward sign of this mutated gene.

The only way to know whether you have it is to do a simple blood test; in Israel if you fit the criteria the test is free.

And in Israel it’s worth checking up. The Holy Land seems to have more of so much: more cars per kilometer of roads than most Western countries, more Nobel Prize winners per capita, more winter sunshine and kosher restaurants. And more mutant genes: God, in His wisdom, endowed his Chosen People with 20 times more BRCA mutations than the general public. The incidence among Jews is so much higher, in fact, that the gene is sometimes known as “the Jewish gene”; when Jolie announced she is a carrier, the Internet lit up with speculation that the actress is Jewish. (She isn’t.) Israel is home to some 70,000 carriers, a huge proportion of whom have never heard of it. And that’s a colossal shame: Knowledge in this case means not only power but also the power to save your own life.

Here’s why: A BRCA gene mutation raises a woman’s lifetime chances of breast cancer to 87%; a five-times-greater- than-average risk. Men’s normal lifetime risk of breast cancer is 0.5%; BRCA2 mutations up this to 6%. Equally unsettling is that the disease often jumps 10 to 15 years each generation: if your mother had breast cancer at 50, you might develop the disease at 35. Should your child inherit the mutant gene, he’s at risk from 25.

There’s more: A woman with the mutant gene has a 50% lifetime risk of developing ovarian cancer (as opposed to 1.5% among the general population). The risk for pancreatic, gastric and biliary tract cancer rises from a normal 1% to 6% for carriers.

Here’s the good news: carriers can lower the chance of developing breast and ovarian cancer by 90% – a prophylactic double mastectomy and removal of the ovaries obliterates the threat.

Radical surgery is not fun, but it does beat dying young. But radical surgery is only one option; regular surveillance – MRIs, ultrasounds, blood tests – can pick up any sign of cancer at a stage where it is still easily treatable.

Thanks to Jolie more women are now being tested; more unrecognized is the fact that men, too, can be carriers. And although for male BRCA carriers the risk of developing cancer is much lower than for females, they do have more chance of developing breast, prostate and pancreatic cancer as well as melanoma. But there is another reason for fathers to be tested: If any relatives had ovarian/breast/pancreatic/ prostate cancer or melanoma, he is a possible candidate for the mutation himself.

If the test turns out positive he can alert his daughters, and possibly save their lives.

Unless he is a follower of Rabbi Joseph Ekstein, the founder of Dor Yeshorim, a premarital genetic screening program designed to eliminate fatal and debilitating genetic diseases in Jewish families worldwide. These diseases include Tay- Sachs, cystic fibrosis, familial dysautonomia and other less common Jewish genetic disorders. In an article titled “Genetic Testing? Only When It Will Do No Harm” published in Ami magazine at the end of December 2016, Eckstein asserts categorically that BRCA testing “has no place in our community” – a community where one in 40 people is a carrier. Among his reasons he also casts aspersions on the scientific knowledge of BRCA researchers and opines that women who test negative might then neglect their health through a false sense of security.

As Blima Marcus, an oncology nurse and researcher on BRCA screening in the Orthodox community writes in her rebuttal, the rabbi might do well to go back to Parashat Nitzavim with its famous commandment to “choose life” (Deuteronomy 30:19). We read that God commands his people: “I call heaven and earth to witness you today: I have put before you life and death, blessing and curse – therefore choose life!” Having the BRCA screening may help everyone – women and men, whether they believe in God or not – to choose life.

For more information (for men and women) please visit generation. Filling out a simple “Prevention GENEration” questionnaire will give you the tools to know whether you are at risk of being a carrier and how to get tested.

Prevention GENEration is a program established by the Israel Cancer Association to raise awareness of the importance of genetic testing and to assist in obtaining a genetic evaluation.

It takes 10 minutes to answer the questions; doing so might add some 40 years to your life, or the lives of your children. It’s worth taking a look.

Shabbat shalom and health, health, health to us all.

The writer lectures at Beit Berl College and the Interdisciplinary Center Herzliya. peledpam@

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