"From Machon Puah"

Medical Secrets - BRCA Mutation

Over the past few months we have been discussing different scenarios concerning the need to reveal medical secrets when considering a shidduch. Today we will discuss the issue of a woman who is found to be a carrier of the BRCA mutation.
An introduction: The body naturally has human tumor-suppressor genes that repair damaged DNA which might cause tumors. All of us have small tumors in our bodies which do not necessarily make us ill, and the task of the suppressor genes is to make sure that these tumors do not get out of hand and become dangerous. If these genes cannot fix the damaged DNA, they simply destroy it.
In certain cases these suppressor genes are damaged due to a mutation and are then incapable of performing their task: they can neither fix nor destroy the damaged DNA. The damaged DNA then may duplicate itself, and this unchecked growth can cause cancerous tumors. This mutation is called “Breast Cancer 1” -  or BRCA - and is carried by 0.3% of the general population. Amongst Jewish Ashkenazi families the statistic is 8.5 times higher: 2.5% of the population are carriers.
This fact is very significant when we considered the ramifications of this mutation as it relates to the incidence of certain types of cancer. It has been published that 56% of ovarian cancer and 19% of breast cancer are related to BRCA mutations. Women with BRCA mutations are at a 35-80% risk of developing breast cancer, and a 27-50% risk for ovarian cancer - depending on which mutation they carry. These women are at a much greater risk for contracting these cancers than the general population of women, where the risk is 12% for breast cancer and 1.5% for ovarian cancer.
Today the medical community recommends that women with the BRCA mutation undergo a gynecological check-up, an ultrasound examination and relevant blood tests twice yearly. Unfortunately it is still unclear medically as to whether this significantly prolongs life expectancy. There have been studies that have examined the efficacy of other possible medical interventions, but so far nothing has proven to be conclusive.
The best medical advice for such a woman is to bear children when she is as young as possible, and then to remove her ovaries; the medical recommendation is that she undergo an oophorectomy (removal of the ovaries) by age 40 or 45. This has been shown to reduce the incidence of ovarian cancer by 95% and the risk of breast cancer by 50%.
The above obviously raises many questions - we will deal with some of the halachic questions in our next column.

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