Knowledge is power – this was a recurring theme stressed by all speakers at a recent program about hereditary breast and ovarian cancer from medical, genetic and Jewish perspectives.

Taking part in the evening at Beth Tikvah Synagogue were doctors Marla Ash and Wendy Meschino, physicians at the Charlotte and Lewis Steinberg Familial Breast and Ovarian Cancer Clinic at North York General Hospital; Rabbi Jennifer Gorman, director of youth activities for the eastern region of United Synagogue Youth; and Natalie Witkin, a social activist who is a breast cancer survivor.

One in nine women will get breast cancer during their lifetime, Meschino said. “For most people, it is rarely due to inherited factors. Usually, it is sporadic, affected by age, hormonal issues [which] may have some genetic component, diet, or alcohol.”

However, she said, the proportion is higher for Ashkenazi Jews. “It’s not that more Ashkenazi Jews get breast cancer, but that a higher proportion get it from a genetic mutation,” Meschino noted.

Jewish families have 10 times higher rate of the BRCA 1 or BRCA 2 genetic mutation – one in 40 carries it, she said.

This higher percentage, Meschino explained, is from the so-called “founder effect,” meaning that it appeared in a small group and remains genetically strong.

The BRCA 1 or BRCA 2 mutations make women more susceptible to both breast and ovarian cancer. In men, it leads to increased risk of prostate, renal and pancreatic cancers.

To answer a question from the audience, Meschino said that Sephardi Jews have a lower risk, but it is still higher than in the general population.

If a family has had multiple cases of  breast or ovarian cancer, especially in those over 50 years old, or a single case in a first-degree relative (mother, sister, grandmother or aunt) under 35, one can assume that there is a genetic link and people should be tested, she said. She added that the mutated gene can come from either maternal or paternal relatives.

Ash said that prevention and early detection are vital in both breast and, especially, ovarian cancer, which has few symptoms, and so by the time it is diagnosed, carries a three out of four death rate.

Carriers of either mutation should conduct regular self-examinations, have a clinical exam by someone qualified every six months and an annual mammogram starting from age 25 to 30.

Breast MRIs can detect more cancers, but they tend to give high false-positive results and are time-consuming and expensive.

There are several ways to lower the risk of these cancers, Ash said. These include prophylactic mastectomy and then breast reconstruction; and prophylactic removal of the ovaries or the whole reproductive system. Though drastic, these procedures  can reduce the risk by 90 per cent.

Ash stressed that it is essential to learn one’s family history, so as to know whether  or not you have those genes and thus have a higher risk of getting breast or ovarian cancers.

Rabbi Gorman said that the issue of prophylactic surgery is being researched in the Conservative movement, both by individual rabbis and the law committee.

Halachah insists that one is obligated to take care of oneself, with the injunction of pikuach nefesh, saving a life, being  primary. However, she said, this is not really pikuach nefesh, as even if one does have the BRCA 1 or 2  mutations, it is not  certain that one will get cancer.

Witkin said that knowing her mother and a relative had the gene mutation didn’t stop her from getting cancer, but she firmly believes that it led to early detection, thus saving her life.

“I never considered my family at high risk for cancer. My family didn’t talk about it, and I didn’t even know that my relative had it. Because I hadn’t asked about it, I didn’t know.”

As a 31-year-old newlywed, Witkin found out she had the gene. She didn’t do anything about it until 2000, when her family was complete. She then booked herself for a mastectomy and oophorectomy (removal of the ovaries). Two weeks before the surgery, she learned she had stage one breast cancer.

Her philosophy is that one must be aware of family medical history and cultural norms. “If someone doesn’t tell you what you need to know, keep asking until  you find out.”

Meschino said that ovarian cancer is know as “the silent disease,” or the whispering disease, because there are few symptoms. Some signs are abdominal bloating, nausea and painful intercourse. However, by the times those symptoms appear, the condition is already advanced and treatment options and the chance of survival are limited.