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BRCA Gene Mutations: Preventative Surgery is Progress, But Not the Promised Land

BRCA Gene Mutations: Preventative Surgery is Progress, But Not the Promised Land

This May, actress Angelina Jolie, made the bold decision to publicly share her courageous, life-saving choice, to have a preventative double mastectomy. Having watched her mother die of cancer at the age of 56, Jolie was counseled to be tested, learned she is a carrier of a BRCA 1 gene mutation, and was told that there was an 87% chance she would develop breast cancer, as well as a 50% chance that she would develop ovarian cancer. Angelina Jolie’s decision was not an easy one.

But, she says: "I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.”

Jolie’s column in the New York Times has brought renewed understanding to all of us who have breast cancer in our families, and should seek medical counsel about whether to be tested. And her column may even lift a degree of fear and mystery around cancer, and around this particular option that some people have to preserve their lives.

And how relevant BRCA gene testing and preventive surgery technologies are for our community! One in 40 Ashkenzi Jews – men and women – carries a BRCA 1 or 2 gene mutation. That means 1 in 40 Ashkenazi Jews can find out that they have up to an 80% chance of developing breast or ovarian cancer, and these genes impact other cancers as well. That means 1 in 40 Ashkenazi Jews can make the difficult but effective choice to pursue the highest of Jewish values – pekuach nefesh, to save a life, with genetic testing, rigorous screening and potentially life-saving preventative surgery.

Many individuals at my congregation have been touched by breast cancer. Recently, Congregation Rodeph Shalom began to develop a way for us here in Philadelphia to allow the impact of Angelina Jolie’s announcement, to reach the Jewish community in a powerful way. In a partnership with the medical leaders of this field, the Basser Research Center of Penn Medicine’s Abramson Cancer Center, our congregation is shaping an awareness campaign for this fall.  With awareness posters in the restrooms during the High Holy Days, and with an awareness symposium with Basser Center director Dr. Susan Domchek, we will help to demystify this important life-saving medical choice, and make medical resources accessible.

Clearly, genetic testing and preventative surgery are difficult to talk about and to imagine for ourselves. It may be empowering to have this technology and this choice, but we are not exactly jumping for joy – our hopes and dreams for cancer research go beyond mastectomies. We don’t want preventative surgery. We want to cure cancer. And to eradicate cancer.

This is not where we want to be at the end of the story of cancer research. BRCA gene mutation detection and preventative surgery is not yet the promised land.

Still, even though we have not yet reached the promised land, we are also not where we used to be – a place with fewer choices, a place of less hope. This moment in cancer research and the opportunity it brings, is one of tremendous progress, and this life-changing point of the journey – is one that we embrace in this moment.

This week, with Parashat D'varim, we have entered the Book of Deuteronomy. It opens with: “These are the words that Moses addressed to all Israel on the other side of the Jordan.” B’ever haYardeyn. On the other side of the Jordan. The entire Book of Deuteronomy takes place on the other side of the Jordan. The Torah has followed our people from the land of Canaan, to the slavery of Egypt, and soon we will reach the Promised Land. But for now, as Professor Elsie Stern points out in the CCAR Journal, for all of Deuteronomy, we are in Moab.

We are not yet where we want to be at the end of the story of this journey – we have not yet reached the Promised Land. Still, we are also not where we used to be, Egypt – a place of slavery. A place without any taste of freedom. A place without hope.  

This moment in Moab and the opportunity it brings is one of tremendous progress, and this life-changing point of the journey, is one that we embrace in this moment.

We may not have reached our destination, but we have moved far from our departure. May we gain understanding and insight in this Moab, and may we move forward in our journey, toward the Promised Land. Amen.

Rabbi Jill Maderer is the associate rabbi of Congregation Rodeph Shalom.

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