"From Machon Puah"

Medical Secrets - Treatment for BRCA

In our last article we discussed the complex halachic question of whether a woman is permitted to remove her ovaries if she is found to be a carrier of the BRCA mutation. Since this mutation is associated with ovarian and breast cancer, the removal of the ovaries could be a significant contributor to her health and well-being.
The removal of a woman’s ovaries, however, can have other major medical implications. It could cause a hormonal imbalance and create symptoms similar to menopause - possibly even more extreme - related to cardiovascular disease, osteoporosis, and changes in other areas of her lifestyle, as well as that of her husband.
Any woman considering this procedure needs to carefully weigh the benefits to her health as opposed to the possible negative effects, and whether the possible risk justifies undergoing the procedure; obviously every case is different.
In recent years the medical community has developed hormone replacement therapy (HRT) - medicines that restore the hormonal balance which has been upset due to the removal of the ovaries. There has been a large and sometimes ferocious debate within the medical community about the use of such HRT’s. Evidence has been presented to suggest that these treatments may not be as safe as was previously thought. The specific type of HRT, when it is administered, and the duration of treatment must be considered, and each case decided accordingly.
It is imperative for a woman in this particular situation to discuss all her questions and concerns with her doctor in order to receive the most comprehensive answers applicable in her specific case.
BRCA Testing: Is it an Obligation?
We have been discussing the BRCA mutation, a common genetic condition that affects the body’s ability to correct or to destroy damaged DNA. When a woman carries this mutation she is at a much greater risk for getting certain types of cancer - particularly ovarian or breast cancer - due to this inability to correct her DNA.
As with Tay-Sachs disease, the BRCA mutation is more common in the Jewish community than in the general society. The question therefore must be asked: does the Jewish community have an obligation to encourage all women to check whether they are carriers of the BRCA mutation?
Genetic testing consists of a simple blood test; the blood cells are then analyzed in the laboratory and results can be provided within a few weeks in order to determine whether or not a person is a carrier of one or more genetic abnormalities. In the past, when genetic testing was first suggested as a way to combat genetic diseases, some Rabbis came out quite strongly against it. Some were afraid it would create panic in the community if people discovered that they were, indeed, carriers. There was also concern as to whether this information would adversely affect the carrier and his family when it came time to seek shidduchim.
The solution that has been adopted is to test for genetic abnormalities and to present the person tested with an identity number, but not the results. When the time comes for such a person to get married, he can check his number against the number of his prospective shidduch. If the computer shows that there is no clash in the results, and the two of them are not both carriers of the same genetic abnormality, there should be no impediment to their marriage.
If it can be ensured that couples who are carriers of a certain genetic abnormality do not get married, we can be assured that no children with these diseases will be born. Over the course of one or two generations, these diseases would then disappear. In this ingenious way the Orthodox Jewish community has come extremely close to eradicating many common genetic Jewish diseases.
In light of this we could suggest that we should do the same for BRCA: if we test for the BRCA mutation we should be able to eradicate the effects of the disease. However, the picture is much more complex than it appears; we will explain why, next time.

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