IF YOU GO• What: "An Ounce of Prevention: BRCA, Genetic Testing and Preventive Measures."• When: 7 p.m. today.• Where: Chabad Jewish Center, 20 Pisgah Ave.• Admission: Free• Phone: 423-490-1106.• Website: www.myJLI.com.CONTINUING EDUCATION"Life in the Balance" is a new six-week, medical-ethics course about the Jewish perspective on everyday medical dilemmas. Continuing medical and legal education credit is available and, according to Rabbi Shaul Perlstein, can help medical professionals develop a greater sensitivity to the concerns and decisions facing some of their Jewish patients. Cost is $99.
A Chattanooga rabbi says Jewish women have what borders on an obligation to check out their risk for carrying a gene mutation that causes breast and ovarian cancer.
"The mandating reason," according to Rabbi Shaul Perlstein of the Chabad Jewish Center, "is because, from a Jewish perspective, you're obligated to take care of your body because you have a mission or purpose in life."
While one in 400 women in the general population carry a BRCA-1 or BRCA-2 gene mutation, according to the National Cancer Institute, one in 40 women of Ashkenazi, or European, Jewish descent carry it. If a woman carries the mutation, there is a 50 to 80 percent risk she will develop breast cancer starting as early as her 20s, and a 20 to 40 percent risk she will develop ovarian cancer as early as her 30s.
Although the risk for ovarian cancer is lower, its death rate is higher since blood tests and ultrasound exams rarely diagnose the cancer until it has already reached stage three or four. At that point, it is more difficult to treat.
"Statistics like these are leaving women in the Jewish community with some tough decisions to make," Perlstein says. "Some are reluctant to get tested, worried about the medical and financial repercussions, and the prospect of facing radical surgeries that could affect their self-image or ability to have children.
"Having to face decisions of such complexity has led many women to avoid addressing the issue altogether. But with mortality rates so high, this is hardly a problem the Jewish community can afford to ignore."
The Rohr Jewish Learning Institute (JLI) in Chattanooga will host a free community awareness workshop tonight on how Jewish law views this medical dilemma. The workshop, titled "An Ounce of Prevention: BRCA, Genetic Testing and Preventive Measures," is the first of a series of six workshops on medical ethics.
Since the gene mutations affect Jewish and non-Jewish people, the workshop is open to anyone and is being offered by JLI in 362 communities nationwide in honor of National Breast Cancer Awareness Month.
In the class, students will be presented with different voices from the medical community as well as the perspective of Jewish law, so they can be prepared to make an informed decision in consultation with their physician and geneticist.
"It's important for people to understand what their individual risk is and how [their family lineage] relates to their overall health," says Karen Edmondson of the Chattanooga Affiliate of Susan G. Komen for the Cure, which focuses on breast cancer research and treatment.
Education can reveal more than a risk of cancer, she says, and may provide clues about other other medical problems.
"The more educated you are," Edmondson says, "the better."
And while the Komen organization doesn't choose between special populations to work with, it supports the JLI's efforts.
In May, actress Angelina Jolie, who tested positive for the BRCA-1 gene mutation and had lost her mother to ovarian cancer and her aunt to breast cancer, revealed she had opted to have a preventive double mastectomy.
"Once I knew that this was my reality," she wrote, "I decided to be proactive and to minimize the risk as much as I could."
Perlstein says Jolie, who has Jewish ancestors, was acting within Jewish law when she made her decision because the risk numbers were so high.
"She had the right to go ahead," he says. It would have been just as appropriate for somebody with the gene to have an oophorectomy, or have their ovaries removed, he says.
In some cases, the frivolous removal of a body part would not be sanctioned, Perlstein says.
"You're forbidden to make a deal with someone to cut off your hand," he says. "It's not ours to give away."
While the spotlight on Jolie made many women more aware of the risks, it also sparked some confusion in Jewish communities, according to Perlstein. It also intensified a debate among geneticists and medical professionals whether all women of Ashkenazi Jewish descent should be tested, or only those with family histories of breast or ovarian cancer, he says.
Until recently, it was believed by some that only women with a family history of these cancers should be screened for BRCA mutations, but Dr. Wendy Rubinstein, director of the National Institute of Health's genetic testing registry and one of the geneticists whose opinions will be shared in the JLI class, calculated that testing all women of Ashkenazi Jewish descent would save 2,800 lives a year and be extremely cost-effective despite the relatively high cost of testing.
"I still believe in family history," she says in information promoting the JLI event. "It tells you an enormous amount. The professional guidelines are that [family history] is enough, and I really don't want to contradict that and say we ought to go farther.
"What I do think is that we ought to think seriously about a screening program as a community like we did for Tay-Sachs (a genetic mutation with higher than normal occurrence in Ashkenazi Jews) ... which was so effective reducing the birth of Tay-Sachs-affected babies. I want to see a dialogue begin between the Jewish community, the medical community, and the public health community."
Others, such as geneticists at the Program for Jewish Genetic Health of Yeshiva University/Albert Einstein College of Medicine, say that, because most BRCA studies have so far been limited to women with a family history of cancer, no one knows for certain whether a positive test result is a conclusive predictor for those with no family history.
Perlstein emphasizes, though, that the presence of BRCA-1 or BRCA-2 gene mutations doesn't ensure a diagnosis of cancer. Some women hear the Ashkenazi tie-in and just refuse to get tested.
"They say they'll just leave it to chance, leave it to God," he says. "At a certain point, you can't say [by law] to leave it to God. I believe if women would be aware of the gene, we could limit the deaths from breast cancer. It's important to know this stuff."
Contact staff writer Clint Cooper at ccooper@timesfreepress.com or 423-757-6497. Subscribe to his posts online at Facebook.com/ClintCooperCTFP.