Healthcare, and in particular women’s healthcare has not only become a buzzword on the political landscape but has captured the attention of potential voters in this highly charged presidential election season. As an ever increasing spotlight continues to shine on this paramount issue, we mark our collective calendars in October which has been designated as Breast Cancer Awareness month. Even the White House was bathed in pink lights on October 15th to recognize the awareness that this month hopes to generate.
Sobering as it may sound, reputable scientific studies reveal that 1 in 8 women in the United States will develop breast cancer over the course of a lifetime. Over the course of the last several years, breast cancer and its implications have garnered international headlines. Such celebrities as Angelina Jolie, Kylie Minogue, Fran Drescher, Rita Wilson and Robin Roberts are those who grappled with cancer and as such have ignited spirited debate and conversation about diagnoses, treatment and prevention.
As women around the globe confront an overwhelming barrage of opinions and options regarding preventive care and treatment choices, often times confusion and even panic prevails.
Recently, the Jewish Voice had the distinct honor and privilege of speaking with Dr. Tamar Peretz, one of the world’s leading breast cancer authorities. Dr. Peretz, (who hails from Israel) is the Director of Hadassah Hospital’s Sharett Institute of Oncology in Jerusalem and is Interim Director General of the Hadassah Medical Organization (HMO).
The Hadassah Medical Organization (HMO) in Jerusalem is a renowned “laboratory” for medical research as it stands at the crossroad of the world, with a diverse worldwide patient population. Indeed, some of the treatment protocols being done at major US medical institutions would not be possible without the work being done at HMO, which also has the distinction of having been nominated for the Nobel Peace Prize.
During her distinguished career as an internationally recognized expert on breast cancer, Dr. Peretz’s genetic research and clinical studies have led to groundbreaking discoveries on BRCA1 gene mutations in the Ashkenazi Jewish community and new prevention, diagnosis, and treatment approaches.
Prof. Peretz serves as the Lawrence Schacht Professor of Oncology at the Hebrew University-Hadassah School of Medicine and has sat on numerous public committees for the advancement of women’s health. She earned her M.D. from the Hadassah-Hebrew University School of Medicine and completed a two-year Fellowship at the Memorial Sloan-Kettering Cancer Center in New York.
The Jewish Voice caught up with Dr. Peretz prior to her participation as a guest panelist at Fran Drescher’s Cancer Schmancer Women’s Health Summit that was held on October 13th at the Skirball Center in Los Angeles. She shared the panel with Dr. Kristi Funk, Angelina Jolie’s breast cancer surgeon.
“As someone who has worked with breast cancer patients for many years, I believe quite strongly that the future of medicine will require that it become more and more personalized,” said Dr. Peretz with a palpable sense of conviction in her voice.
While continuing the focus of early detection of breast cancer through annual mammograms and MRIs are important factors in treatment, Dr. Peretz’s molecular and genetic research points to the fact that the risks for Ashkenazic Jewish women remain significantly higher.
As one who has treated more Ashkenazi Jewish patients than any other doctor in the world, Dr. Peretz speaks of central focus of her research; namely the BRCA1 and BRCA2 genetic mutations. It appears that women of Ashkenazic descent (those with family origins in Eastern Europe) face a 1 in 40 chance of having such a mutation. This increases their lifetime risk of developing breast and/or ovarian cancer up to 84 percent, according to a recent JTA report.
The first evidence for the existence of such a gene was provided by Mary-Claire King’s laboratory at UC Berkeley in 1990. Four years later, after an international race to find it, the gene was cloned in 1994 by scientists at University of Utah, National Institute of Environmental Health Sciences (NIEHS) and Myriad Genetics.
BRCA1 and BRCA2 are normally expressed in the cells of breast and other tissue, where they help repair damaged DNA or destroy cells if DNA cannot be repaired. They are involved in the repair of chromosomal damage with an important role in the error-free repair of DNA double-strand breaks. If BRCA1 or BRCA2 itself is damaged by a BRCA mutation, damaged DNA is not repaired properly, and this increases the risk for breast cancer. Thus, although the terms “breast cancer susceptibility gene” and “breast cancer susceptibility protein” (used frequently both in and outside the medical literature) sound as if they describe an oncogene, BRCA1 and BRCA2 are normal; it is their mutation that is abnormal.
While 1 out of 40 Ashkenazic Jewish women carry this gene mutation, says Dr. Peretz, she adds that “1 in 350 non-Jewish women also have this mutation.”
“We are also working assiduously to identify specific mutations in non-Ashkenazi and non-Jewish populations,” she continued.
Because Israel boasts an exceptionally diverse population, the ethnic mosaic continues to be a challenge for those in the health field.
“There is one mutation among Yemenite Jews, one mutation among Jews from Kurdistan and one mutations for the Sephardic community as well,” Dr. Peretz says.
She adds that this gene mutation can also be responsible for the diagnosis of colon cancer, pancreatic cancer and prostate cancer.
Interestingly enough, Dr. Peretz observes that young men under the age of 30 who carry this gene mutation may be more sensitive to radiation.
“At Hadassah Hospital, we have created a clinic for the high risk population and we are in a very good position to identify this at an early stage,” declares Dr. Peretz.
In addition to the study of BRCA1 and BRCA2, Dr. Peretz says that other genes that are responsible for developing breast cancer are also being studied.
“We are studying the molecular pattern of tumors and several molecules are being studied for treatment,” she says. “Our concern” she says is the “prognosis of the tumor and how it will interact with chemotherapy.”
Touching on new drug development such as PARP Inhibitors and drugs that target HER2 protein; Anti-angiogenesis drugs and Everolimus, Dr. Peretz is confident that tremendous inroads have been made.
Whether all Ashkenazic Jewish women should be tested for the BRCA1 and BRCA2 mutation is still a subject of intense debate, strong opinions in favor of it have now appeared in numerous publications including the New York Times.
Recently diagnosed with breast cancer, bestselling author Elizabeth Wurtzel penned an emotionally charged op-ed piece in the Times in which she implored Ashkenazi Jewish women to be tested for the BRCA gene. In her article entitled, “The Breast Cancer Gene and Me,” Wurtzel speaks with frankness about her own bilateral mastectomy and constant chemotherapy regime. She concludes that “All Ashkenazi Jewish women should have the BRCA test.”
Dr. Peretz, on the other hand is not an advocate of universal testing for all women and even believes that not all Ashkenazi women should be tested. She has stated that the implications of testing must be carefully considered because the patient often finds themselves having to make a difficult decision of whether to tell her family. And this, of course, comes on top of just finding out that she has been diagnosed with cancer.
She adds that when a woman is told that she is a BRCA gene carrier this also means that there is a 50 percent chance that she closest relatives are carriers as well.
With the advent of BRCA home testing kits, DNA home testing kits, preventative mastectomies and hysterectomies, and inconsistent recommendations regarding mammograms, there is a lot of confusing information circulating in the universe of breast health but Dr. Peretz gives context to the matter and generously shares her insights with her patients as well as audiences around the world.
.Providing emotional support to breast cancer patients is definitely a priority for Dr. Peretz. “We work with women from all backgrounds. We have found that women who are Holocaust survivors often experience high levels of anxiety and depression. They are like a thin layer of ice. They find it next to impossible to talk about their fears and concerns in group therapy and require personalized counseling.”
She adds that even the second generation of Holocaust survivors “inherit the psychological tenure of their mothers. They are vulnerable and require emotional support and the strength of friends and relatives as well.”
Dr. Peretz is proud of the outreach work that Hadassah does in terms of having their doctors and nurses pay particular attention to women from lower socio-economic backgrounds who often do not have access to healthcare.
“We have physicians going to Arab villages as well as communities in which Ethiopian and Russian women reside. We try and create awareness of breast health and urge early detection through testing,” she said.
“For all of us here at Hadassah, the health and quality of life for all women, from all backgrounds, all ethnicities and all races is our top priority,” she said.