Recently, I received an article against BRCA genetic screening penned by a R’ Boruch Weiss, titled, “The Evil Trap of Mass BRCA Testing: Yidden, Do Not Fall for This!”
Evil?
The article is a potentially deadly formula that could cause needless deaths and untold suffering to thousands of families. B’chasdei Hashem, Hashem has given the world medicine and testing so that we can take preventive measures in screening for cancer. The gedolei Yisrael have signed kol koreihs about the necessity of cancer screening. And this rabbi has taken it upon himself to disagree with the einei Yisrael?
First, some background.
The BRCA Genes
There are two genes called “BRCA1” and “BRCA2.” Some people have mutations in these genes, and these inherited mutations predispose women to extremely high risks of breast and ovarian cancer. Carriers of a BRCA1 mutation face a lifetime breast cancer risk of approximately 70%. They also have an ovarian cancer risk of between 30% and 40%. For carriers of the BRCA2 mutation the breast cancer risk is slightly less—approximately 50%—while the ovarian cancer risk is 1 out of 5.
Let’s assume that a typical Jewish girls’ high school has about 400 students. One in 40 Ashkenazi Jews carries a BRCA mutation. That means that if we follow R’ Boruch Weiss’s recommendations, we are throwing “only” ten of our precious young women to the wolves. “And who cares about 10 out of 400? We will still have 390 that are fine” seems to be his thinking.
Doesn’t R’ Boruch Weiss know that BRCA mutations account for 11% of all breast cancers and 40% of all ovarian cancers in the Jewish population?
R’ Weiss writes: “There is currently a huge push underway in some countries (I am aware of England and the U.S.) to do mass genetic testing on the entire Ashkenazi Jewish population, to check for a genetic mutation which they claim gives a person a higher risk of developing cancer, Rachmana litzlan.”
They claim? Great, let’s now cast doubts and aspersion on the cancer researchers who dedicate themselves b’lev v’nefesh to help people.
He further writes: “I have done a lot of research, and what I have found is very concerning. I am extremely worried about the impact that this genetic testing would have on Klal Yisrael.”
Let’s get this straight: Thousands of people who have spent several years researching the connection between BRCA and cancer, and you write that you have done “a lot of research.” And because of this research of yours, we should throw into the garbage all the carefully documented studies and statistical analysis and only listen to you? Even go against the kol koreihs about cancer screening from the gedolei Yisrael?
R’ Weiss continues, “I spoke with a senior talmid chacham about the mass BRCA testing, and he was in absolute agreement about the severe damage it would chas v’shalom cause, and encouraged me to be mefarsem this article.”
So, you spoke with an unnamed senior talmid chacham, and we have no idea whether you mentioned to him any of these studies. Nor do we know whether you mentioned to him the ten girls in every girls’ school across the country whose futures you have destroyed if we listen to you.
He further writes: “Personally, I quite suspect sinister motives on the part of the NHS, I’m sorry to say. There is way too much evidence in the last couple years that the NHS is keen on decreasing the population, not on saving lives.”
Aha! So, according to your writing, these cancer researchers are really murderers, keen on killing us with this call for genetic testing.
It is sad when people who would seem to be otherwise observant Torah Jews are actually undermining Torah because of their grandiose conspiracy theories. The prevention and minimization of disease is a Biblical imperative. The pasuk in Devarim (4:15) “V’nishmartem me’od l’nafshoseichem” is understood by the Gemara and the poskim to mean that safeguards and measures must be taken to ensure our personal health and safety.
We really need to protect Klal Yisrael from people with a radical agenda that pushes anti-medicine conspiracy theories. The Jewish media should not allow people with views that undermine Torah and just plain normalcy a voice.
Breast cancer affects Jewish Ashkenazi women by an astounding 1,200% more than it affects the general populace. Dr. Jonathan Herman, a well-respected ob-gyn with a practice on Long Island who has delivered thousands of our children, explained, “There is no question that every Ashkenazic female in our shuls and Jewish community centers should be tested for this. It affects one in forty women.”
Kallah Teachers
In recent years, someone came up with the idea to have our kallah teachers advise kallahs to start taking folic acid even before they get married. The rise in folic acid in the bloodstream before marriage probably helped many fetuses develop normally, preventing many diseases. Based on discussions with expert doctors in the field of oncology, and a few gedolei ha’rabbanim, it is this author’s view that the kallah teachers should make two additional recommendations.
They should all strongly recommend that upon the first birthday of her first child, or by age 25 after marriage, each woman should be tested for BRCA. The idea of the first birthday is to address the fact that if the kallah gets tested near marriage or near a birth, she could develop unhealthy anxieties. The second recommendation is that on the 1-in-40 chance that the woman tests positive, at the age of 35 (or 40) she should opt for bilateral oophorectomy surgery. This is a surgery that would normally be prohibited for other women, but, in the view of many poskim, based upon the data in the study results published in the Journal of Clinical Oncology, is halachically recommended for women who do test positive for BRCA1 or BRCA2.
Why the age of 25 or at the first birthday of a baby? This is the first time that action could be taken that might make a difference, and a good percentage of these young ladies would be married by that time, too. At 25, those who tested BRCA positive could then be taught more advanced self-examination techniques and be put on safe medications that reduce the incidence of some cancers by 50%.
The study involved almost 6,000 women and showed that carriers of the BRCA mutations had an 80% lower risk of ovarian cancer if they underwent bilateral oophorectomy.
Oophorectomy also was associated with a 77% reduction in the hazard for all-cause mortality, owing primarily to the effect on ovarian and breast cancer risk. Dr. Narod said in a statement. “These data are so striking that we believe prophylactic oophorectomy by age 35 should become a universal standard for women with BRCA1 mutations.” He continued that, “Women with BRCA2 mutations, on the other hand, can safely delay surgery until their forties, since their ovarian cancer risk is not as strong.”
Among women with intact ovaries, 98 of 108 ovarian cancers occurred in BRCA1 carriers and 10 BRCA2 mutation carriers. Cancer diagnosis occurred most often during ages 50 to 59 for BRCA1 carriers and 60 to 69 for the BRCA2 carriers.
General Prohibition
According to the Talmud (Shabbos 110b), the Torah forbids “sirus”—actions that render a person incapable of having children, based on the verse in Vayikra (22:24), “That which is bruised, crushed, torn, or cut do not bring before Hashem. Neither shall you do this in your land.”
The Tosefta (Makkos 5:6) cites a debate as to the status of females in this prohibition. It is the view of Rabbi Yehudah that regarding females, one is patur, exempt.
The Rambam in Hilchos Issurei Biah (16:11) and the Shulchan Aruch (E.H. 5:11) both seem to rule that such operations are generally forbidden but exempt. The Shulchan Aruch in the next halachah rules that while it is forbidden to physically render a woman incapable of having children, a woman may ingest a liquid which will cause her to be incapable of having children.
There is a debate as to whether sirus in regard to women is a Torah prohibition or a rabbinic one. The Vilna Gaon (E.H. 5:25) understands both the Rambam and the Shulchan Aruch as holding that the prohibition is indeed from the Torah; it is just that the prohibition does not carry with it the punishment of lashes. The Aruch HaShulchan (E.H. 5:22) is of the same view. The Rashba, Tosfos, Meiri, and Smag all hold that it is rabbinic.
Regardless as to the status of the prohibition, the Acharonim all rule that for great need this prohibition may be set aside. Certainly, this would be true regarding an issue of pikuach nefesh.
In the past, some questioned whether these recommendations should be implemented on account of two factors: (1) the anxiety that some of the women will experience in knowing that they carry the gene; and (2) whether there was evidence that the surgery would alleviate the situation.
However, recent studies have put this issue to bed. Both statistics have been validated. Eighty percent of women with the gene mutation are prone to the cancer, and 80 percent of the women who have the surgery at age 35 avoid the cancer.
The issue is pressing. Women who have a family history of these illnesses should definitely get screened for BRCA1 and BRCA2.
The author can be reached at Yairhoffman2@gmail.com. Read more of Rabbi Hoffman’s articles at 5TJT.com.
