A little more than two years ago, the U.S. House of Representatives unanimously approved House Resolution 1522, designating the last week in September as National Hereditary Breast and Ovarian Cancer (HBOC) Week and the last Wednesday of the month as National Previvor Day. Ironically, when Rep. Debbie Wasserman Schultz (FL-20) first introduced the resolution in July 2010, just weeks after I’d lost my mother to breast cancer, I didn’t even know what the HBOC community was, let alone that I, together with Rep. Wasserman Schultz, was among its ranks. That all changed in August 2010, when the results of a simple blood test to check for the presence of BRCA (an acronym for BReast CAncer) gene mutations revealed that I do in fact carry one of these mutations, which we surmise I inherited from my mother.
Healthy BRCA genes—without mutations—function as tumor suppressors, helping the body fight off rapid and unregulated cell growth. Individuals with a BRCA gene mutation have a significant risk of developing breast and/or ovarian cancer within their lifetime—often at an earlier age than those in the general population. Although a woman’s risk of developing one or both of these diseases varies based on her personal family history and the specific gene mutation she carries (there are hundreds of different BRCA mutations), for those in the HBOC community, the risk of breast cancer can be as high as 87% (vs.12% in the general population) and as high as 50% (vs.1.5% in the general population) for ovarian cancer. Men, too, can carry BRCA mutations, which increase their lifetime risk of developing breast and prostate cancer. Like women, they can inherit a mutated gene from their father or their mother and, also like women, there is a 50% chance they’ll pass the mutation along to their children—both sons and daughters. BRCA mutations also are associated with pancreatic cancer and melanoma, as well as with fallopian tube and primary peritoneal cancer. Unlike some genetic diseases, such as Tay Sachs, in which individuals must inherit two “recessive” genes—one from their mother (who is a carrier) and one from their father (who also is a carrier)—in order to develop a particular disease, BRCA gene mutations are “dominant.” Inheriting just one BRCA gene mutation puts an individual at increased risk of developing cancer at some point during his or her lifetime. At the same time, some people with BRCA mutations will never develop either breast or ovarian cancer—some because of luck of the draw and others because they elect to take chemoprevention drugs or to have prophylactic surgeries to remove their breasts and/or ovaries, greatly minimizing their risks. These individuals, survivors of a genetic predisposition to cancer, are known as “previvors.”
As it always does, Hereditary Breast and Ovarian Cancer Week bridges Ovarian Cancer Awareness Month in September and Breast Cancer Awareness Month in October. This year, by coincidence it fell right in the middle of the High Holy Day season—with National Previvor Day on Yom Kippur. Then again, perhaps it’s not really such a coincidence—BRCA mutations are more prevalent among Ashkenazi Jews than in any other ethnic population. Overall, one in every 500-800 people is a BRCA mutation carrier, while among Ashkenazi Jews, approximately one in every 40 people (2.5% of the population) is a carrier, and most carriers are not aware of their BRCA status. Even though the majority of Ashkenazi Jews are not BRCA mutation carriers and only five to 10% of all breast and ovarian cancers are caused by BRCA mutations, it is important to know the possible signs of these hereditary cancers. These include a family member with:
- Ovarian or fallopian tube cancer at any age
- Breast cancer before age 50
- Breast cancer in both breasts at any age
- Both breast and ovarian cancer
- Triple negative breast cancer
- Male breast cancer
Other signs of hereditary breast cancer include more than one relative on the same side of the family with any of these cancers:
- Breast cancer
- Ovarian or fallopian tube cancer
- Prostate cancer
- Pancreatic cancer
If you suspect that you or a family member may be affected by HBOC, you may wish to contact a genetic counselor, who is specially trained to assess individuals’ personal cancer risks and help determine appropriate risk management strategies. The National Society of Genetic Counselors can help you find genetic professionals in your area. Facing Our Risk of Cancer Empowered (FORCE), an organization solely devoted to the HBOC community, also can provide resources and information helpful to you and your family.
Even if your family is not touched by HBOC, it is important to recognize the presence of hereditary cancer risk in the lives of countless families—many of them Ashkenazi Jews—and, in light of HBOC Week, to acknowledge the struggles and triumphs these families face in heeding our tradition’s call to “choose life so that you and your offspring shall live.”