Ashkenazi Jewish women are five times more likely than the general population to have gene mutations that greatly increase the risk of breast and ovarian cancers.
Does Jewish law obligate them to be tested for the mutations?
If they test positive, are they obligated to take preventive measures — such as having their breasts or ovaries removed — to reduce their risk?
Those were the intriguing questions posed in a class I attended last month at the Lussier Community Education Center on Madison’s West Side.
The class, “An Ounce of Prevention,” was the first of a six-part course about biomedical ethical issues, called “Life in the Balance,” that continues this month in Madison and more than 300 cities around the country.
The course is offered by the Rohr Jewish Learning Institute in New York. Locally, it’s led by Rabbi Avremel Matusof, director of Young Jewish Professionals of Madison. For more information, go to www.myjli.com.
The first class focused on BRCA1 and BRCA2, genes for which mutations increase the risk of breast and ovarian cancers by four times or more. In the general population, about 1 in 500 people have one of the mutations. Among Ashkenazi Jews, who make up most Jews in the U.S., the prevalence is about 1 in 40.
Many Americans became familiar with the genes in May when actress Angelina Jolie revealed she had her breasts removed to greatly reduce her risk of breast cancer after learning she had one of the BRCA mutations. She reportedly said she also plans to have her ovaries removed.
According to Jewish law, saving one life is like saving an entire world, Matusof said. But scholars who wrote the Talmud some 1,500 years didn’t consider whether people should get genetic tests that could potentially save their lives, he said.
Jewish law suggests approaches to the modern-day dilemma, Matusof said. Here’s how he answered the questions:
• People whose parents have a BRCA mutation should be tested.
• Jewish women who have been diagnosed with breast cancer likely have an obligation to be tested.
• For other Jewish women, the decision can be handled case by case, based on other risk factors.
• Jewish women who test positive are obligated to pursue heightened surveillance for breast cancer, such as earlier and more frequent mammograms and MRIs. There is no obligation for surgery to remove the breasts.
• Jewish women who test positive face a possible obligation to have their ovaries removed, generally after their childbearing years. That is because the fatality rate for ovarian cancer is much higher than for breast cancer.
In Jewish law, the body “is God’s property,” Matusof said. “We have no right to tamper with it.”
But people can take risks in order to participate in societal activities if the chance of serious danger is less than about 3 percent, he said. Driving, flying and swimming are OK, he said. Skydiving? Not so clear.
“Jewish law allows one to assume risks ... as long as they seem reasonable and not reckless,” Matusof said.
Upcoming sessions of “Life in the Balance” will address aborting one life to save another, autopsy and anatomical dissection, compensation for organ donation and uterus transplants. Regardless of your faith, or whether you have one, it’s interesting to think about such medical quandaries in a religious context.