Women who have been diagnosed with breast cancer can benefit from a strong support network. Support might come from family members and friends, rabbis, and community members. For Jewish women concerned about privacy, support can also come from breast cancer organizations and Jewish organizations that offer confidential counseling and services.
Jewish women have been the subject of much recent research in the field of hereditary breast cancer. While there is still debate as to whether general breast cancer rates are higher in Jewish women as
compared to women in the general population, research scientists have determined that Ashkenazi Jewish women have an increased genetic susceptibility to breast cancer. Genetic counseling and genetic testing can help determine if a woman carries an altered gene that could increase
Ashkenazi Jewish women have an increased genetic susceptibility to breast cancer
her risk of developing breast or ovarian cancer. The course of action a woman may choose to pursue with that information is the subject of considerable discussion.
If you have already been diagnosed with breast cancer, learning more about your genetic background may influence your surgery and treatment decisions. If you have not been diagnosed with breast cancer, learning more about your genetic background may help you identify options that could reduce your risk of developing cancer or assist in detecting cancer early. As with all important medical decisions, be sure to discuss your unique concerns with a health care professional.
Frequently Asked Questions
What are BRCA1 and BRCA2?
Alterations in two genes identified as BRCA1 and BRCA2 make carriers more susceptible to developing breast and ovarian cancers. Inherited alterations in the BRCA1 or BRCA2 genes account for up to 5-10% of all breast cancer cases. Researchers are searching for other genes that may also increase a woman’s cancer risk.
The likelihood that breast cancer is associated with BRCA1 or BRCA2 is highest in families with a history of multiple cases of breast cancer, cases of both breast and ovarian cancer, one or more family members with two primary cancers, or families of Ashkenazi Jewish background. However, not every person in such families carries an alteration in the BRCA1 or BRCA2 genes.
How do alterations in BRCA1 and BRCA2 affect a Jewish woman’s risk of breast cancer?
A woman’s lifetime risk of developing breast cancer is greatly increased if she inherits an altered BRCA1 or BRCA2 gene. Recent studies suggest that the risk may be as high as 50%-80% for those carrying mutations. It is important to note that not all carriers of a BRCA1 or BRCA2 mutation will develop breast cancer.
Among individuals of Ashkenazi Jewish descent, researchers have found that approximately 1 in 40 carry an altered BRCA1 or BRCA2 gene, compared to 1 in 345 in the general population. Among people with alterations in the BRCA1 or BRCA2 genes, three particular alterations have been found to be most common in the Ashkenazi Jewish population—two in the BRCA1 gene and one in the BRCA2 gene. While there is still debate as to whether breast cancer rates are higher in Jewish women as compared to the general population, the proportion of breast cancer that is hereditary is higher in Jewish women of Ashkenazi descent.
How are BRCA1 or BRCA2 mutations inherited?
Both men and women who carry a BRCA1 or BRCA2 mutation may pass that alteration on to their sons and daughters, whether or not they are diagnosed with cancer themselves. Not all children of people who have an altered gene will inherit the alteration, and not all of those who inherit the alteration will develop breast cancer in their lifetime.
What is genetic testing?
Genetic testing is a process through which it is possible to look for genetic alterations in the BRCA1 and BRCA2 genes. Testing is done on a blood sample. The person’s blood is drawn in a laboratory, doctor’s office, hospital, or clinic, and the blood sample is sent to a laboratory to check for alterations in the BRCA1 and BRCA2 genes.
Where can I get more information about genetic testing for breast cancer risk?
A person who is considering genetic testing should speak with a professional trained in genetics before deciding whether to be tested. Genetic counseling is a health service that helps people identify and understand what particular traits they may have inherited. Health professionals who are certified as genetic counselors provide genetic counseling. They can be trained in a variety of disciplines, including biology, genetics, psychology, public health, and social work.
Genetic counselors are trained to be sensitive to your background and should not urge you toward any particular course of action. They will supply the information you need to make your own decisions based on your family history, the genetics of breast cancer, the benefits and risks of testing, the implications of positive and negative results, and any factors that may influence your decision about whether you want to proceed with genetic testing. They can also explain issues of confidentiality and insurance reimbursement for counseling and testing.
If you opt for testing, genetic counselors will help you understand the implications of the results for you and your family members. Genetic counselors in your area may be found by contacting your physician, a major medical center’s genetics program, a cancer center, or the National Society of Genetic Counselors at www.nsgc.org.
How should I be monitored if I test negative for a BRCA1 or BRCA2 mutation?
If you test negative for a BRCA1 or BRCA2 mutation, it may be useful to consult with a genetic counselor or other health care professional (e.g., breast surgeon or gynecologist) about appropriate screening and surveillance. Your health care team can help you determine the best methods for monitoring breast and ovarian health. They can also keep you apprised of developments in genetic research and testing as it becomes available.
What are my options if I test positive for a BRCA1 or BRCA2 mutation?
A positive test result indicates that a person has inherited a known mutation in the BRCA1 or BRCA2 gene and has an increased risk of developing certain cancers. A positive result provides information only about a person’s risk of developing cancer. It cannot be used to predict whether cancer will actually develop – or when. Not all women who inherit an altered gene will develop breast cancer.
If you have already been diagnosed with breast cancer, test results may influence your surgery and treatment decisions. If you have not been diagnosed with breast cancer, test results may help you make choices that could reduce your risk of developing cancer or help detect cancer early. Genetic counselors can guide you and should explain all of your options thoroughly.
Your options may include:
• Increased surveillance: You may choose to be monitored more closely for any sign of breast or ovarian cancer. This may include more frequent mammograms and sonograms, MRIs, breast exams by your doctor, and breast self-exams, as well as transvaginal and pelvic sonograms and more frequent exams by your gynecologist.
• Risk-reducing surgery: You may choose to have at-risk breast and/or ovarian tissue removed in order to reduce the risk of developing cancer.
• Chemoprevention: You may choose to use natural or synthetic substances, such as the drug tamoxifen, to reduce the risk of developing cancer or to reduce the risk that cancer will return.
• Participation in a research study: You may choose to join a research study that is exploring ways to reduce cancer risk.
What impact will genetic counseling or testing have on the other members of my family?
The information you receive can influence your family members’ health care decisions. A genetic counselor can help you determine the ways in which your family can be affected by testing and how health information can be shared responsibly.
What are my options if I choose not to be tested?
Should you choose not to be tested, a health care professional (e.g., breast surgeon or gynecologist) can help you determine appropriate screening and surveillance. You can also learn more about breast and ovarian cancer risk, and speak with your doctor about healthy lifestyle choices.
Are there any issues of Halacha, or Jewish law, related to hereditary breast cancer or genetic counseling and testing?
Questions of Halacha may arise with regard to surgery and treatment decisions. These questions are best addressed by your Rav or Rabbi, who will answer them with sensitivity to your unique medical situation.
The above information is reprinted with permission from the Breast Cancer Genetics and the Jewish Woman, copyrighted 2005 Sharsheret, Inc. All rights reserved to Sharsheret: Linking Young Jewish Women in Their Fight Against Breast Cancer
The information provided is for informative purposes only and in no way is intended to give either medical or halachic guidance. Please consult your doctor or rabbi for any questions in these sensitive areas.