Surgeon Laura Esserman compares the need to screen for breast cancer, especially among people of Ashkenazi Jewish ancestry, to the routine checks travelers readily accept before boarding a plane.
“It’s like finding people on the no-fly list,” Esserman said at San Francisco’s Congregation Emanu-El on Oct. 30 in a session called, “Jewnetics: Breast Cancer, BRCA and Beyond.” “How do we find people at the most risk?”
Esserman and Dena Goldberg, a genetic counselor at UCSF, told the audience that screening is especially important for people who have a history of cancer in the family — a trait significantly higher among Ashkenazi Jews than among the general population.
Goldberg said all Ashkenazi Jews today come from an original group of about 350 people in Eastern Europe who often intermarried over the centuries. BRCA is a tumor-suppressing gene that can mutate and lose its ability to stop cancer cells from forming. Among Ashkenazi Jews, 1 in 40 have the BRCA mutation — a rate 10 times higher than the general population.
Only about 10 to 20 percent of people with the mutation know they have it, Goldberg said, and screening would make the others aware they face an increased risk for breast and ovarian cancer.
The BRCA mutation also is a danger for men, since it is increasingly linked to prostate and pancreatic cancer. Of the 75 people in the audience for the talk at Emanu-El, only 10 were men.
“When I have a patient who’s female, I talk to them about male relatives,” Goldberg said. “I give a lot of talks to the community that men should be coming to also.”
Esserman, a breast cancer oncology specialist, stressed that not everyone needs to be screened and that she understands many people’s reluctance to do genetic testing. For those at higher risk, though, screening at an early age is important — especially since 35,000 to 40,000 people die of breast cancer in the U.S. each year.
“How do we take this from being scary and hysterical and make this about general breast health and health overall?” she asked. “Fear is a not a good motive to intervene, you have to know the facts and know what you’ve got and treat it appropriately. I believe that knowing your risk will help you make better life choices.”
Emanu-El Rabbi Carla Fenves drew laughs when she said some women had asked her whether marrying a non-Jew would decrease their chances of passing on Ashkenazi mutations. She said she informed them that interfaith marriage would not entirely block those mutations.
“There are a lot of reasons to choose a partner, but that should not be one of them,” Fenves said.
Esserman is leading an effort to get 100,000 women to join in a national screening program called the Wisdom Study (wisdomstudy.org), which has just become available in the Bay Area. The goal is to demystify and simplify the screening process, making it accessible for more women.
BRCA screening began in 1996 and has changed little in the last two decades, Esserman said. Other cancer screening is similarly rooted in the past century.
“It’s high time we have a modern-era screening trial,” she said.