By Becca Bakal 

Much of the liturgy around Yom Kippur centers on the unknowns in our lives. In particular, the poem Unetanah Tokef, which we read on Rosh Hashanah and Yom Kippur, focuses on the mysteries of the future. The poem describes how each person’s fate is written and sealed during the High Holidays, including who will live, who will die, and how they will pass on. The text also lists various blessings and challenges that may be part of someone’s life.  

This metaphor of fate being “inscribed” in the Book of Life or the Book of Death is similar to how people often talk about their genetics. On more than one occasion, I’ve had a friend with a strong family history of cancer say, “Well, I guess I’m doomed.”  

The poem’s descriptions of life and death seem to confirm that many of us will meet an unhappy end, even if we don’t know it yet:  

How many shall pass away and how many shall be born,  
Who shall die in old age, and who before their time, 
Who shall live and who shall die, 
Who shall perish by water and who by fire, 
Who by sword and who by wild beast, 
Who by famine and who by thirst, 
Who by earthquake and who by plague, 
Who by strangulation and who by stoning, 

The poem paints a picture of various characters in a book—they may not yet know what will happen to them, but their story is unfolding along a predetermined path.   

While our liturgy emphasizes that aspects of our lives are out of our control, that’s not the only message. Unetaneh Tokef also tells us that we have the opportunity—and responsibility—to take ownership over our lives through our actions. After the laundry list of blessings and curses, the poem continues: 

But repentance, prayer, and righteousness annul the severe decree. 

According to this tradition, we do have an opportunity to alter the course of our lives. That’s true, too, when it comes to genetics. Our genetics may increase our chances of a specific disease, but DNA is not fate.   

In particular, there are various ways that you can reduce your genetic risks. Take the opportunity of these High Holy Days to protect your family’s health. Here are a few steps you can take: 

• If you’re planning to start a family or you know someone who is, then seek out carrier screening. Screening before pregnancy gives couples the most options 

• To address your risk of cancer: 

  • Gather your family’s health history and share it with your healthcare provider 

  • Seek out regular cancer screening. If you are not sure how often to get screened or for what, ask your healthcare provider or talk to a genetic counselor 

The Sarnoff Center wishes you a sweet New Year, and an easy fast.  

By Carol Guzman

This past summer was very busy at the Sarnoff Center!

Our associate board members spearheaded a program in July about gene-editing, “CRISPR: Is Gene-Editing Kosher?” A few weeks earlier, we were the presenting sponsor for JCC Chicago Generation J’s Shabbat on the Lake where we hosted a variety of learning programs for 700 young adults. And we started preparations on our upcoming events, Jean Therapy and “What’s Jewish about BRCA?”  But summertime is also when we get started on a very important fall project we first started in 2014.

With the High Holy Days comes the Sarnoff Center’s annual Rosh Hashanah gift bag initiative! The Sarnoff Center provides participating synagogues and Jewish communities with small gift bags to distribute to congregants for the Jewish new year. Each bag contains a caramel-apple lollipop, a honey stick and an insert that explains our programs and upcoming events.

This past week our staff distributed nearly 11,000 bags to 35 congregations and Jewish groups around Chicagoland. That’s more communities than we’ve ever reached before!

For the second year in a row, we partnered with our friends in Keshet’s GADOL program to assemble gift bags. GADOL offers vocational opportunities for young adults with intellectual and developmental disabilities, and we were beyond thrilled when they agreed to help turn bag assembly into a project for GADOL team members again this year. We truly appreciate our partnership and hope it continues for years to come.

We hope everyone receiving the bags this Rosh Hashanah enjoys the sweet treats and learns a little bit more about the programs and services we have to offer.

L’shana tovah from the Sarnoff Center staff!

By Carol Guzman

The BRCA gene gets its name from breast cancer, a disease commonly linked to mutations of the gene. But a BRCA mutation indicates much more than just an increased risk of hereditary breast cancer in women. These mutations are also associated with ovarian cancer in women, breast cancer and prostate cancer in men, pancreatic cancer, and melanoma. Individuals of Ashkenazi Jewish ancestry may face an elevated lifetime chance of BRCA-associated cancers because they are 10 times more likely to inherit a BRCA gene mutation compared the general population.

Let’s discuss some of the lesser-known and lesser-addressed BRCA-associated cancer in honor of Prostate Cancer Awareness Month and Ovarian Cancer Awareness Month.

Ovarian Cancer and BRCA

The National Cancer Institute estimates that 17% of women with an inherited BRCA2 mutation and 44% of women with an inherited BRCA1 mutation will develop ovarian cancer by the time they are 80 years old.

Ovarian cancer is often called a “silent killer” because detecting it in its early stages is extremely difficult. Many ovarian cancer symptoms are vague and mimic things that women typically deal with regularly: bloating, constipation, abdominal and pelvic pain, fullness after eating, and menstrual changes. Women who notice these changes in their bodies should talk to their doctor if the symptoms persist for more than a few days.

There are no preventative screening tests or early-warning signs for ovarian cancer. Ovarian cancer is detectable once it occurs, but the methods used aren’t perfect. The most common are the transvaginal ultrasound (TVUS) and the CA-125 blood test. TVUS uses sound waves to look for growths inside the uterus, but it can’t identify whether a tumor on the ovaries is cancerous or benign. The blood test method checks for elevated levels of the CA-125 protein, but false positives are possible because elevated levels of CA-125 can be caused by other conditions.

Prostate Cancer and BRCA

One study estimates more than 9% of men with a BRCA1 mutation and 20% of men with a BRCA2 mutation will develop prostate cancer in their lifetimes. Some men with prostate cancer may not develop symptoms. Others experience difficulty urinating, weak or interrupted flow of urine or frequent urination, pain or burning during urination or ejaculation and constant pelvic and back pain.

Similar to ovarian cancer, there is no failproof preventative screening test for prostate cancer at the moment. A prostate cancer diagnosis can only be made with a prostate biopsy, which requires 12 small samples of the prostate to be removed and further examined. Two screening tests are commonly used, including a blood test for prostate-specific antigen levels and a doctor’s examination by hand; however, the latter is not recommended by the U.S. Preventive Service Task Force.

BRCA-Related Cancers and Genetic Testing

Meeting with a genetic counselor and, if appropriate, getting genetic testing for BRCA mutations can help identify your risk early. If cancer occurs, genetic testing can also be vital in determining which cancer treatment is appropriate for you. Ovarian cancer patients with BRCA mutations may be candidates for a new targeted therapy called a PARP inhibitor, in which an enzyme stops cancer cells from repairing themselves. Doctors use the same PARP inhibitor to treat prostate cancer patients and breast cancer patients with a BRCA mutation. Currently, there are clinical trials involving the PARP inhibitor for individuals with BRCA-associated cancers that may result in more  treatments.  

Ovarian cancer has caused more women’s deaths than any other cancer in the female reproductive system, and prostate cancer is the most common male cancer in the United States. Both cancers are difficult to catch in their early stages, but learning more about your genetic health and speaking to a genetic counselor can empower you to know whether you have a higher risk of developing these cancers and, if necessary, take steps to reduce any risk. This month consider talking to your healthcare provider about how ovarian or prostate cancer may affect you.

Picture Credit: Darryl Leja, National Human Genome Research Institute, National Institutes of Health 

This month, the U.S. Preventive Services Task Force (USPSTF) updated their recommendations on prevention of BRCA-related cancers. The new recommendations, published in the Journal of the American Medical Association (JAMA), expand upon previous guidelines developed in 2013 and now include recommendations for individuals of high-risk ancestry.  What does this mean for Jewish women? We’ll break it down.

What is the U.S. Preventive Services Task Force?

The USPSTF is an independent, volunteer panel that provides evidence-based recommendations on what preventive services primary care clinicians should offer their patients. The Task Force assigns letter grades to each service it reviews to indicate the balance of expected benefits and harms, as well as the level of certainty based on scientific evidence.

Interventions with the grades A or B are recommended, and the Affordable Care Act requires private insurers to cover those services with no cost-sharing (i.e., there is no out-of-pocket cost to the patient). The Affordable Care Act also requires Medicaid to cover those services and authorizes Medicare to do so. 

What did they recommend before?

The USPSTF previously recommended that primary care providers screen women with a family history of breast, ovarian, tubal, or peritoneal cancer to identify whether they are appropriate candidates for genetic counseling and possibly BRCA testing.

This screening involves the clinician going through a risk assessment questionnaire or checklist. The risk assessment can identify a family history suggestive of a possible BRCA1/2 mutation. If screening indicates that hereditary cancer may run in a patient’s family, her primary care provider should then refer her to genetic counseling.

What are they recommending now, and how is it different?

The updated recommendation adds women who have ancestry associated with BRCA1/2 gene mutations and women with a personal history of breast, ovarian, tubal, or peritoneal cancer to the list of those who primary care providers should screen for hereditary cancer risk. The recommendation does not specifically mention any ethnicity or ancestry, but Ashkenazi Jewish ancestry is most strongly associated with BRCA1/2 mutations. 1 in 40 women of Ashkenazi ancestry carries a BRCA1/2 mutation compared to about 1 in 300 women in the general population.

What does this mean for you?

Primary care providers and women’s healthcare providers often already ask their female patients about family history of cancer. This recommendation encourages them to also ask about ethnicity and prior personal cancer diagnoses and use that information to initiate screening for hereditary cancer risk. If you meet the criteria, most insurance should cover this screening with no out-of-pocket cost to you. These recommendations apply to anyone assigned female at birth, as BRCA-related cancer risks are tied to biological sex.

The risk assessment screening relies on information about family health history, so the screening is most effective if you know about any history of cancer in your parents, grandparents, aunts, uncles, siblings, and children, including their age at diagnosis. You can find family health history tools on the Sarnoff Center website.

If you are a woman with Ashkenazi Jewish ancestry and you have not yet discussed hereditary cancer risk with your primary care provider, your next checkup is a great time to start the conversation—and to mention that you have Ashkenazi Jewish ancestry.

For additional information and discussion of this change see:

• Journal of the American Medical Association editorial by Dr. Susan Domchek and Dr. Mark Robson, as well as the accompanying news release
• Interviewwith Carol Mangione, member of the USPSTF

A flow chart below describes the updated recommendation.