Are Ashkenazi Jews More Susceptible to Breast Cancer?

Lisa Jablon | Photo provided

Dr. Lisa Jablon has seen many strides in breast cancer treatment since she first entered the field about 30 years ago.

The Cheltenham native, who has been at Einstein Heathcare Network ever since graduating Temple University School of Medicine, began in general surgery at a time when it was uncommon for women to work in that area. Now, she serves as director of Einstein’s breast health program and leads the breast surgical team.

It was a natural fit, she recalled.

“A lot of patients were interested in seeing a woman,” remembered Jablon, who became a Bat Mitzvah at Congregation Adath Jeshurun, “and over time, I got to enjoy the practice, got more interested in it, started going to a lot of meetings that were related to breast cancer research, and it was kind of a natural fit.”

In this time, she’s seen some major advancements in treatment and surgery, such as reconstructive surgery.

“How a patient looks at the end if they choose mastectomy is remarkably better than what it was when I first got into practice,” she explained. “A lot more choices, options, improvements, skin sparing, nipple sparing. That has really been a big change.”

Another big change is the practice of sentinel node biopsy, in which “the sentinel lymph node is identified, removed and examined to determine whether cancer cells are present,” as explained by the National Cancer Institute.

“Of course, there’s been tremendous strides in breast cancer treatment in the medical arena — chemotherapy, hormone therapy, tailored therapies … genetics,” Jablon added.

However, there are still strides to be made and there is more information Jablon wants women to be aware of this Breast Cancer Awareness Month, particularly Ashkenazi Jewish women.

Per the Susan G. Komen Breast Cancer Foundation, in the United States, breast cancer risk is slightly higher among Jewish women than other women.

According to the Centers for Disease Control and Prevention (CDC), about one in every 500 women in the country has a mutation in either her BRCA1 or BRCA2 gene, the most well-known genes linked to breast cancer risk.

Per Komen, that range can expand even up to one in 800 women.

However, it varies among ethnic groups.

The CDC reports that one in 40 Ashkenazi Jewish women has a BRCA gene mutation.

But don’t let that scare you — it’s still a rare mutation.

“If you look at it another way,” Jablon said, “of all women who have breast cancer who are Ashkenazi Jewish, only about 10 percent will have inherited that mutation.

“I’d say Ashkenazi Jews are a little bit higher risk of developing breast cancer in the United States compared to other people, but it’s not dramatic,” she said, “because 90 percent of them will have a sporadic cancer like everybody else and only 10 percent would have the mutation that makes them at increased risk.”

To determine your risk for developing cancer, there is genetic testing available, and Jablon hopes more women learn about it.

“Any Jewish woman who develops breast cancer would actually be eligible for genetic testing,” she said, “because we try to not test everybody because the mutation’s pretty rare, but in Ashkenazi Jewish women, it’s about 10 percent. So even if you don’t have a family history, just being Jewish and having cancer would make you eligible.”

Testing is one way to know for sure what your risk is, as there are not many other true tests to determine what makes one more susceptible to developing breast cancer.

Two key factors are genetics and age, Jablon noted.

“In terms of other things I think people are interested in,” she said, citing common questions like whether to avoid red meat, “unfortunately, there haven’t been a lot of specific environmental things that we can show in association with breast cancer to tell people what to do or what not to do.”

For her, amid the negatives, there are positives to breast cancer, especially as technology advances and treatments change.

“It’s one of the cancers we have been able to cure in a lot of people with a combination of a variety of different techniques — with a combination of surgery, sometimes radiation, systemic therapy, chemotherapy, hormone therapy,” she said. “There are many people who have it one time and are never affected again throughout their lives and luckily it never comes back. So I think our ability to cure cancer has definitely improved over the years.”

Advancements in surgery have also helped reduce the rates of re-incisions, which Jablon hopes will only continue to improve.

At Einstein, they piloted a device created by an Israeli company called MarginProbe, which “looks at the edges of the tissue that you remove at surgery to see whether you have removed it all,” Jablon said.

“Reducing that event, that second surgery, is really an important thing,” she said, “and with the use of this device, we have seen that our re-incision rates have dropped significantly.”

They’ve used it on about 50 patients so far, she said. As it is fairly new, there are still kinks to be worked out with the product, and she noted it is expensive, but she hopes that it will continue to advance and improve in the future.

She hopes that women — Jewish women in particular — learn more about genetic testing to determine their risk.

“I don’t think the disease is different for Jewish women compared to anybody else other than that genetic component that may be more prevalent,” she said, “so to be aware of that would be a key thing to let people know about, and they may not know.”

With scientific and technological advancements, hopefully it won’t be needed at all in the future.

“Hopefully, we’ll eradicate cancer soon,” she said. “It’s hard to know whether that’s going to be in the immuno world or genetic world, but I think it will be discovered. It’s just a matter of when and from what vantage it’s going to come from.”

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