Looking good in those genes


Your day begins with a cup of joe, and to get through the afternoon, you’ll be gulping down a few more: There’s a gene for that. 

Caligenix, a genetics-based lifestyle company in Brentwood, can help people find out whether they have that caffeine-craving gene variation, along with many others that affect health and lifestyle. The company’s services are based on the science of nutritional genetics — how genes influence metabolism, diet, nutrition and response to exercise — and begin with a simple sample of saliva.

For some time now, scientists have been saying that the future of preventive health lies in knowing a person’s genetic makeup. After the Human Genome Project was completed in 2003, many predicted that genetic testing would soon provide people with an accessible and reliable way to improve their health and lifestyle. But the ability to do so was still a long way off. 

But in May of last year, dentist Tzur Gabi and entrepreneur Eliad Josephson co-founded Caligenix, providing genetic testing, interpretation and recommendations through their network of providers, which includes registered dietitians and nutritionists, a holistic coach and a lifestyle coach. 

After collecting a sample of a client’s saliva, Caligenix sends it to a CLIA- and CAP-accredited clinical laboratory in San Diego, where it is tested for 78 genetic markers that impact metabolism.  

Within two to three weeks, the results are returned to Caligenix, where a provider interprets them, gleaning information like whether the client would benefit more from endurance training — such as mid- or long-distance walking, jogging or bicycling — or strength training; whether she is susceptible to Achilles tendon injuries, so she’ll know when and how to stretch; why he doesn’t feel satiated after a meal and has difficulty resisting dessert; and whether she is prone to particular vitamin deficiencies. After interpreting the genetic test, providers give the client actionable plans focused on nutrition and exercise. The cost to clients is between $495 and $995, depending on insurance coverage.

Gabi, Caligenix’s chief medical officer, likens genetic testing to a road map to the body. 

“Let’s say I asked you to drive to Tulsa, Okla. Wouldn’t you ask for a map? Or would you make your way without a guide?” Gabi said. “Genetic testing is the map I give my patients to get to Oklahoma.” 

Gabi’s dental practice is what he calls “genetically guided” — all of his patients receive the genetic test. His office has an in-house registered dietitian nutritionist, who develops a preventive genetic-based meal plan for each patient.

The test reveals how the body processes sugars, fats, nutrients and vitamins — all of which, Gabi said, play a role in dental health. 

“Low levels of vitamin C have been shown to be associated with an increased risk of periodontal disease, increased permeability of the oral mucosa to bacterial toxins [and] impaired immune response,” Gabi said.  

Vitamin C deficiency can ultimately lead to scurvy. The vitamin is also vital in forming the amino acids needed to produce collagen for bone formation and calcification to support the teeth, as well as for wound healing. 

“Deficiencies of protein, vitamin D or calcium may lead to the [resorption] of bone around the teeth and destruction of the periodontal ligaments that anchor the teeth to the jawbones,” Gabi said. “Women with severe osteoporosis are three times more likely to experience tooth loss.” 

Because an individual’s genes are present at birth and remain the same for their entire life, anyone can take the test at any time. 

Mor Levy, a registered dietitian nutritionist who specializes in lactation, believes that “in the ideal world, the test should happen when you are born.” Levy is a Caligenix provider who has a practice in Calabasas. 

The earlier you understand what is optimal for your body, Levy said, the more preventive action you can take. This knowledge might help parents, for example, understand the eating habits of a picky child or their sensitivity to lactose.

Levy starts by asking patients about their diet and exercise regimens. She also asks for as much of their own and their family’s medical history as they can provide. But there are often holes in this narrative, and even with a complete history, one can’t know whether a parent’s gene might be recessive in the next generation. Rather than rely on this incomplete information, Levy encourages testing, which takes the guesswork out of one’s genetic makeup. 

“Even if you do know your ancestry, that doesn’t mean you will have the gene that causes a heart attack,” Levy said.

But back to the question of coffee addiction. The gene linked to this is CYP1A2; a liver enzyme that is encoded by this gene is responsible for metabolizing caffeine. Variation at a marker for this gene results in different levels of enzyme activity and, therefore, different rates of metabolizing caffeine. 

“The test shows how quickly you metabolize caffeine,” Levy said. “If you metabolize it faster, this means your body will eliminate it quicker, thus you won’t stay caffeinated as long.” 

Caligenix’s plans for 2015 include continuing to spread awareness of the benefits of nutritional genetics through the company’s integration into many types of practices, including gyms, wellness centers and health care providers. They also offer genetic tests for the breast cancer susceptibility gene BRCA and other genetic diseases, but the primary focus is on genetic testing to improve healthy lifestyles.

“Right now, this is one more tool for [health] providers,” Josephson said. Genetic testing, he added, is “one more scientific tool to help them understand how to deal with an issue.” 

Jewish genetic testing offered


Tammy Rubin wasn’t thrilled at the prospect of getting blood drawn by a phlebotomist. At least there was apple juice — and the prospect of life-changing knowledge — afterward.

The UCLA junior was sitting at a table outside of the campus’ Kerckhoff Hall on April 9, where the Los Angeles Jewish Genetic Disease Prevention Project and Progenity lab offered genetic screenings for both Ashkenazic and Sephardic Jews.

“It was so easy, so fun — well, less fun about the shot stuff — but all the phlebotomists were there cheering you on,” Rubin said. 

The event was in coordination with Hillel at UCLA and GeneTestNow (genetestnow.com), an organization encouraging Jews to undergo genetic screening before starting a family. The latter is an initiative of the Doris Factor Endowment Fund of the Jewish Community Foundation of Los Angeles and supported in part by TRIBE Media Corp., parent company of the Jewish Journal. 

The same event was held a day earlier at Hillel at USC. Together, the two-day project attracted nearly 100 people, according to one of Progenity’s project leaders. Participants will receive their test results — offered for $25 to those with insurance — after a few weeks.

Through tests like these, people can learn which genetic diseases they carry, even though they do not show its traits or symptoms. Because most Jewish genetic diseases are recessive, both parents need to be a carrier for a disease to impact the health of a child.

The discomfort of getting blood drawn, Rubin said, was more than worth it when considering the risks of not knowing whether she has the recessive genes carried by many Jews. 

For Ashkenazim with roots in Central and Eastern Europe, that could mean one of 19 genetic diseases. Not just high-profile ones like Tay-Sachs disease, but also lesser-known illnesses like nemaline myopathy, a muscle disorder, and Canavan disease, a progressive, fatal neurological disease.

Debby Hirshman, a consultant who traveled from New York to help organize the events, recalled meeting a Jewish couple in Atlanta who were tragically impacted by not having a genetic test done that was comprehensive enough. 

The couple’s first child was a healthy boy, but their second child, a daughter, reached few, if any, of her milestones by the time she was 4. A blood test revealed that she has mucolipidosis type IV (ML4), a neurological disorder, which, in this case, Hirshman said, will cause the girl to go blind at the age of 10 and prevent her from ever talking. Neither spouse knew they were carriers of the disease because one was tested for only four diseases and the other checked just eight. 

Awareness about some genetic disorders within the Ashkenazic community is widespread, but Hirshman said that when she spoke with Los Angeles rabbis before arranging the local events, each one indicated a willingness to publicize the testing as long as it included common genetic diseases within the Persian, Mizrahi and Sephardic Jewish communities.

Traditionally, Hirshman said, the barrier to getting people in the door for these tests is not hesitation at getting blood drawn or fear of hearing potentially negative news — it has been the cost. To address that, participants with insurance only had to pay $25 — a fraction of the normal cost of such comprehensive genetic testing procedures, which can easily run more than $1,000.

That was possible because the lab Progenity agreed to absorb the risk of insurance companies not paying the full bill, according to two local women who spearheaded these events, Heidi Bendetson and Stacy Sharf.

The testing process at both USC and UCLA was so quick, most people could be in and out in less than 30 minutes — unless, of course, they wanted to stick around to enjoy additional cookies and juice, and chat with the Progenity staff, who were more than happy to schmooze between consultations.

After signing in and registering, every participant was given the opportunity to interact with a Progenity genetic counselor, who explained the basics of recessive genes and why participants shouldn’t be disheartened if they are carriers. Modern techniques such as in vitro fertilization can help reduce the risk of two carriers having a child with a particular disease.

Following the counseling session, the unpleasant part — drawing blood — generally took less than a minute.

Shawn Feldman, who spoke with the Journal shortly before giving blood, said that any discomfort he has from getting tested is far outweighed by the knowledge that he will soon have.

“It’s not really fun for me,” said Feldman, a first-year pharmacy graduate student. “But I see it as a very, very small and transient price to pay for such a great benefit to so many people.”

The next Jewish genetic testing event in Los Angeles will be held at Wilshire Boulevard Temple on May 13, from 5 p.m. to 9 p.m. For more information, visit this article at jewishjournal.com.

Need for genetic testing raised by new initiative GeneTestNow


Significant advances in science enable us to no longer question what’s in our genes. This is especially important for Jews, who are far more likely to be carriers of certain genetic diseases than the general population. 

Education and awareness about genetic screening have been spreading throughout the nation and the December 2012 launch of the Web site “>victorcenters.org.

How much does it cost? Insurance companies often dictate the price tag for genetic screening. Some won’t offer a covered benefit until a woman is pregnant, since there is no liability until this point and testing earlier is considered a waste of resources. Costs can range from as little as $99 to thousands. 

Is a salvia test a good genetic screening? To eliminate all risks of being a carrier of Tay-Sachs disease, you should request to screen for DNA and enzymes, which can be done only with a blood test. Otherwise the test will screen only for DNA mutations, which misses a small percentage of carriers. 

Should I get rescreened before having another child? Hold on to your test results. It isn’t a matter of rescreening, but of updating your screening as technology advances and more information becomes available. In 2005, the Jewish panel of diseases covered only nine genetic diseases. 

Are online genetic screening tests sufficient? Direct-to-consumer testing might not provide counseling services, which are strongly recommended. To ensure the quality of testing, laboratories should be properly certified. The Center for Medicare and Medicaid Services regulates lab testing through the Clinical Laboratory Improvement Amendments (CLIA). Check to make sure the screener is CLIA approved. 

Consider purchasing life insurance first. Test results from genetic screening could make it difficult to buy life insurance, disability insurance or long-term-care insurance. Although, Congress passed the Genetic Information Nondiscrimination Act of 2008 to protect Americans against discrimination based on their genetic makeup from health insurers or employers, not all types of insurance are included. 

Genetic study offers clues to history of North Africa’s Jews


A new genetic analysis has reconstructed the history of North Africa’s Jews, showing that these populations date to biblical-era Israel and are not largely the descendants of natives who converted to Judaism, scientists reported on Monday.

The study also shows that these Jews form two distinct groups, one of which is more closely related than the other to their European counterparts, reflecting historical migrations.

The findings are the latest in series of genetic studies, which began in the 1990s, indicating that the world’s Jews share biological roots, not just cultural and religious ties. In many cases the analyses have confirmed what scholars had gleaned from archaeological finds and historical accounts.

“This work demonstrates a shared genetic history among the Jews of North Africa and strengthens the case for a biological basis for Jewishness,” said medical geneticist Harry Ostrer of the Albert Einstein College of Medicine in New York, who led the study.

For the new analysis, published in the Proceedings of the National Academy of Sciences, Ostrer and his colleagues examined the genomes of 509 Jews and 11 non-Jews from North Africa, which is home to the second-largest Jewish diaspora. Only the European diaspora, which includes American Jews, is larger.

The scientists found that the Jewish populations of North Africa became genetically distinct over time, with those of each country carrying their own DNA signatures. That suggests they mostly married within their own religious and cultural group, said Ostrer. “They lived in ghettos,” he said, “so their mobility was quite restricted, and by marrying each other they became as closely related as first cousins once removed.”

The analysis showed that all North African Jews are descended from forebears in the Middle East, supporting the hypothesis that biblical-era Israelites among Phoenician traders established colonies along the North African coast.

Common DNA signatures also show that some groups are closer, genetically, to their European co-religionists than expected. That suggests “a shared set of founders,” said Ostrer, presumably Jews from the Middle East who migrated west.

If Jewish populations in North Africa and Europe shared ancestors, then Sephardic Jews who settled in Africa after being expelled from Spain during the Inquisition originated in North Africa more than 1,000 years earlier. “The Sephardic Jews show significant North African ancestry,” said Ostrer. “That could reflect bidirectional migrations” to and from North Africa and Europe over the centuries.

EXODUS FROM EGYPT

DNA evidence lends credence to accounts that in 312 BC Egypt’s king settled Jews in Cyrenaica, in what is now Tunisia. According to the Jewish historian Josephus (born in AD 37), by the first century AD there were 500,000 Jews there. The DNA that Tunisian Jews share with those of the Middle East supports accounts that, after the destruction of the second temple in Jerusalem in AD 70, 30,000 Jews were deported to Carthage, in what is now Tunisia.

North African Jews fall into two genetically distinct groups: those of Morocco and Algeria and those of Tunisia and Libya. The former are more closely related to Europeans, suggesting that when the Sephardic Jews were expelled from Spain in 1492 and from Portugal in 1497 most of those escaping to North Africa put down stakes in the first lands they reached rather than traveling farther east.

Experts not involved in the new study saw no major surprises but credited it for the breadth of its findings.

“What’s new here is the inclusion of several Jewish communities whose DNA had not been studied before, such as those of Tunisia and Georgia,” said geneticist Marcus Feldman of Stanford University, co-author of a 2009 study that found significant genetic similarity between European and Middle Eastern Jews.

Including Georgian Jews led to one surprise: that they are closely related to those of the Middle East, including those in Iraq and Iran. “That shows there was significant migration of Jewish populations along the Silk Road beginning in the Persian Empire,” said Ostrer. “Just a small number of founders started Jewish communities in India, Burma, and Georgia.”

The Jews of Ethiopia are so distantly related to other Jews that their community must have been founded by only a few itinerants who converted local people to Judaism and then married within the local population. It also suggests the founding was more than 2,000 years ago.

That antiquity helps explain why Ethiopian Jews airlifted to Israel during “Operation Moses” in 1984 had no idea about the holiday of Hanukkah, which commemorates events of the second century BC—long after their ancestors had left Israel. (Editing by Douglas Royalty)

Genetic research can open book on Jewish identity — for good and bad


Father William Sanchez wears a Star of David pendant on the same chain as his crucifix, and he keeps a menorah in his parish office. After a DNA test confirmed his Sephardic roots, the Albuquerque priest has been actively reconciling this discovery with his Catholic beliefs.

“Knowledge of my Jewish ancestry has provoked me to question things, yes,” Sanchez says in the book, “Abraham’s Children: Race, Identity and the DNA of the Chosen People” by Jon Entine (Grand Central, 2007).

Looking back over his childhood in New Mexico, Sanchez now recognizes the Jewish signs: his parents shunning pork, spinning tops during Christmas and covering the mirrors at home if someone in the family died.

For Crypto-Jews like Sanchez, DNA testing services can confirm or disprove suspicions about a hidden Jewish family history, uncover unknown genetic disease risks or inspire greater exploration of Judaism. For small populations in Africa and Asia, genetic research has shed light on claims of Jewish ancestry and provided a better understanding of Jewish migration over thousands of years.

But critics fear that Jewish genetic research also opens a Pandora’s box. The discovery of a shared genetic marker among men who claim to be descended from Kohanim grew into wild, exaggerated claims in the media that geneticists had confirmed the story of Aaron. Some have decried research exploring a genetic basis for Ashkenazi intelligence as politically incorrect and racist, since all humans are 99.9 percent similar.

Entine, who will be speaking at Adat Chaverim and Brandeis-Bardin this weekend, believes exploring that .1 percent is worth getting researchers riled up.

An American Enterprise Institute fellow and former NBC news producer, Entine is no stranger to controversy. He tackled the topic of race in sports with “Taboo: Why Black Athletes Dominate Sports and Why We’re Afraid to Talk About It” (PublicAffairs Books, 1999), which was lauded by Scientific American as a “well-researched, relatively thorough and lucidly written case.”

After “Taboo” was published, Entine learned his sister had breast cancer. As a teenager, he had lost his mother, grandmother and aunt to cancer over a period of three years. The family assumed it was a coincidence at the time, but recent genetic testing revealed the BRCA2 genetic mutation contributed to his sister’s cancer.

Since Entine has a young daughter, he decided to undergo testing, which confirmed he carries the mutation. The experience inspired him to research the link between Jews and DNA.

The result is “Abraham’s Children,” a survey of Jewish genetic research paired with a chronicle of Jewish history that explores the thorny question: “Who is a Jew?”

Entine writes that Jewishness is a function of religion and ancestry, shaped by faith, politics and culture. Given the Jewish community’s historically insular nature, most Jews also share genetic markers, which speaks to common ancestors.

This commonality inspired research in the 1990s that found the Cohen Modal Haplotype, a set of six identical genetic markers shared among Ashkenazic and Sephardic Kohanim, passed from father to son on the Y chromosome, which doesn’t change much over time and may have originated with a common ancestor. While the genetic markers alone do not prove the existence of Aaron, they can be seen to confirm a biblical tradition.

The haplotype, however, is also not unique to Jews — Kurds, Armenians, southern and central Italians share these same markers but to a lesser extent.

Researcher tracing Jewish genes meets the Kohanim of Africa [VIDEO]



Dr. David B. Goldstein from Duke’s Institute for Genome Sciences and Policy talks about tracking the genetic history of the ancient Jewish priesthood (kohanim) and the Lost Tribe of Israel, the focus of his new book, “Jacob’s Legacy”.

For many people, genetics research conjures up frightening notions of racial or religious superiority — or the possibility of genetic discrimination. David B. Goldstein isn’t worried about either of these things.

“I take the view that there isn’t anything to be afraid of in our genetic makeups. So I really think that it’s interesting, fascinating even, sometimes important, but there isn’t anything scary lurking there,” said Goldstein, a professor of molecular genetics and the director of Duke University’s Institute for Genome Sciences and Policy’s Center for Population Genomics &Pharmacogenetics.

Goldstein, 44, even applies his open-research policy to a scientific study a few years ago that linked genetic diseases to intelligence among Ashkenazi Jews. He calls that work “speculative,” but he doesn’t rule out research into the issue.

“That doesn’t mean that you don’t have to be really careful in how you present what’s been done,” he said. “I think you do, and I think we’ve seen mistakes in how work is presented. I think it’s really reckless to overstate results. But I don’t think there are any areas that are unwise to investigate, because I’m just not afraid of what we’re going to find.”

In “Jacob’s Legacy: A Genetic View of Jewish History,” recently published by Yale University Press, Goldstein uses the latest genetic methods — including genetic mapping and advanced DNA testing — to illuminate compelling issues in Jewish history like the biblical priesthood, the Lost Tribes, Jewish migration, and Jewish genetic diseases.

Goldstein’s most startling finding: There are enough Y chromosome similarities among many who call themselves descendants of the Cohanim, the biblical priestly caste, to argue for genetic Cohen continuity.

He and his colleagues tested these similarities by comparing the Y chromosomes of Cohanim with the chromosomes of other Jews. Sure enough, the majority of the self-identified Cohanim, whether Ashkenazi or Sephardi Jews, had the same type of Y chromosome. Further testing by Goldstein and friends leads him to estimate that the Cohanim were founded before the Roman era — and perhaps before the Babylonian conquest in the sixth century B.C.E.

Even Goldstein was blown away.

“The apparent continuity of the Cohen Y chromosome was an out-and-out stunner; I would have never predicted that to be the case,” he said.

He also finds genetic evidence for the idea that the Lemba tribe in Africa might have some Jewish origins, a finding that the media simplified by saying he had shown the Lemba are one of Judaism’s 10 Lost Tribes.

In the section on the Lemba, and indeed throughout the book, Goldstein is careful about his conclusions. For him, the research is more about shedding light on themes of Jewish history, such as exile and Diaspora. As he puts it in the book, “What makes a people a people? What binds them together through time? What alienates them from some and aligns them to others?”

As admirable as the book’s scholarship is its readability. Goldstein’s jargon-free writing and sense of humor courts readers who are not hard-core scientists. At different points in the book, he calls himself a “lousy mathematician” and as “having a bit of the gambler in my genes,” and, in the section about the alleged link between genetic diseases and intelligence, he writes, “Now we geneticists have a genuine kerfuffle on our hands.”

Don’t be misled — Goldstein’s book isn’t “Jewish Genetics for Dummies.” But he has taken cutting-edge science and made it accessible to the general reader willing to make an effort.

It wasn’t easy, admitted Goldstein, whose academic work focuses on medical genetics — specifically, why some people control HIV better than other people and why some people respond better to some medicines than other people.

“I started writing this just about 10 years ago. The discussions of the science were dreadful, incomprehensible. And so I just tried it again and again until I found ways that worked and that people didn’t complain about when I showed it to them.”

Part of the motivation for the book, Goldstein says, stems from guilt he feels because he remained in graduate school at Stanford and didn’t go to Israel when the 1991 Gulf War broke out.

“I did feel like I should do something. And I think doing some work eventually at least gave me some kind of connection to read about Jewish history as part of my job, and that definitely made me feel better. I guess I finally got over it and started going to Israel regularly, which I still do.”

He’s frank about the limitations of genetic history. “[G]enetics can never, however, replace, or even compete with, the painstaking work of archaeology, philology, linguistics, paleobotany and the many other disciplines that have helped resurrect some of the lost stories of human history,” Goldstein writes.

Understandably, though, he’s proud that his research has yielded some insight into some vexing issues, and shares the notion that what he is doing on some issues — say, the Cohanim — borders on the fantastic.

“The continuity of the Cohen paternal line is an astounding thing,” he said. “And it’s a little tiny bit of history that genetics tells you about.”

Peter Ephross’ articles and reviews have appeared in the Village Voice, the Forward and Publishers Weekly, among other publications.

Briefs


It’s in the Genes

Back in the 1970s, there was a major push to get Jews screened for Tay Sachs before they got married. If two parents carry the Tay Sachs gene, a child could be born with the deadly disease. The push was highly successful, but geneticists now worry the effect may be wearing off, as the number of couples who get screened for Tay Sachs has dropped, while the number of babies born with the disease seems to be on the rise.

This and other issues will be the topic of discussion at “New Frontiers in Jewish Genetics: Who Owns Your Genes?” on Saturday, Nov. 10.

Gene therapy, cloning and stem cell research are all likely to come up as panelists discuss the medical, ethical and historical background to predominantly Jewish genetic diseases, such as Gaucher, cystic fibrosis and Canavan disease.

The forum will feature Dr. Avraham Steinberg, a professor of medical ethics at Hebrew University-Hadassah Medical School and Shaare Zedek Medical Center in Jerusalem, who will examine halachic and medical issues in genetic testing, therapy and engineering. He will be joined by Dr. Lawrence Platt, professor of Obstetrics and Gynecology at UCLA; Dr. John A Barranger, from the Department of Human Genetics at the University of Pittsburgh; and Dr. Rena Ellen Falk, medical director of prenatal diagnosis at Cedars Sinai and professor of pediatrics at UCLA.

Sponsored by Young Israel of Century City, Hadassah of Southern California and the Health Care Professional Division of Orthodox Union West Coast, the evening is being paid for by a grant from the Genzyme Corporation, which develops diagnostic tools and therapies for genetic diseases.

Steinberg will also be the guest at Young Israel of Century City, 9317 West Pico Blvd, Nov. 9-10, addressing the congregation Friday night on the topic of being an observant doctor in Israel, and on Saturday afternoon on the topic of cloning.

For reservations for the Saturday night forum, call (310) 508-7753. For information about Shabbat at Young Israel, call (310) 273-6954. — Julie Gruenbaum Fax, Religion Editor

Beit T’Shuvah Declares Independence

After 14 years of working together, Gateways Hospital and Mental Health Center and Beit T’Shuvah have parted ways.

As of September, Beit T’Shuvah, the rehabilitation center for addiction treatment, has become an independent nonprofit entity. Now operating as a 501(c)(3) under the auspices of The Jewish Federation of Greater Los Angeles, Beit T’Shuvah will continue with President Warren Breslow and Founding Executive Director Harriet Rossetto continuing in their respective positions.

Located near Echo Park, Gateways Hospital and Mental Health Center had its genesis in the Jewish community, stemming from the Jewish Committee for Personal Service more than 80 years ago. Since 1987, when the hospital undertook the Beit T’Shuvah program, Gateways’ mandate has been to serve the community at large, said Ken Weinberg, Gateways director of community relations.

Beit T’Shuvah’s decision to leave the Gateways fold was an amicable decision in the works for several years, said officials at both institutions.

Breslow and Rossetto, through Friends of Beit T’Shuvah, raised nearly $5 million to purchase and refurbish the West Los Angeles facility last year. The treatment center now accommodates more than 100 residents, up from the 29 serviced at its original downtown Los Angeles Lake Street address.

According to Rossetto, the approach to fundraising will remain the same at Beit T’Shuvah. Solicitations for donor support will continue, and Beit T’Shuvah’s annual benefit dinner, held each January, will continue in 2002 with a tribute to philanthropist Annette Shapiro. Last year’s dinner brought in $500,000.

The treatment center will remained unchanged in terms of programming, location and personnel and, except for the hiring of a business administrator, the only difference will be on paper. — Michael Aushenker, Staff Writer

Turning Knowledge into Power


The connection between Jewish women and cancer is unsettling, even terrifying, yet undeniably real. Too many have been diagnosed to be simple coincidence. What’s happening to Jewish women? What can we do about it?

On December 9, 1999, the University of Southern California/Norris Comprehensive Cancer Center, the Jewish Federation and Hadassah hosted the conference “Cancer Genetics: Health, Hope and the Jewish Family.” The conference brought a group of physicians and experts to the Skirball Cultural Center in Los Angeles to explore those questions and try to provide some answers. “We care that our community get the facts that can make the difference in their lives,” said Federation President John Fishel.

The problem, according to conference speakers, is in our genes. In 1994, two genes were discovered — BRCA1 and BRCA2 — that significantly increase a woman’s risk of breast and ovarian cancer. And, unfortunately, Jewish women are about 10 times more likely to carry one of these mutations than the general population. “If the individual is an Ashkenazi Jew,” says Alexandra Levine, M.D., medical director of the USC/Norris Cancer Hospital and chief of USC School of Medicine’s Division of Hematology, “the chances of carrying one of those genes is about one in 40, or two-and-a-half percent.”

And the effects of those genes are profound. According to Levine, the lifetime risk of getting breast cancer for a carrier of BRCA1 is 50 to 85 percent. The risk of ovarian cancer is somewhere between 15 and 45 percent. And the lifetime risk of getting a second primary cancer if you’ve already had one is 40 to 60 percent. The risks associated with BRCA2 are about the same.

But the idea conference speakers stressed most was that although the numbers are frightening, they are also empowering. Because knowing that these genes exist means we can test for them, and when they’re found in an individual, we can act.

“If we know that the gene is there, we might allow early detection,” says Dr. Levine. And there is now a host of preventive measures women can take, everything from birth control pills, to drugs like tamoxifen, to prophylactic surgery. While none of these measures eliminates the risk of cancer, they can reduce it significantly. And knowing you’re a BRCA carrier means you can discuss those options before cancer ever appears.

So how do you know if you should be tested for the BRCA genes? The most telling signal is family history. “If you have two or more relatives on the same side of the family with cancer, as a geneticist, I would look at that person more carefully,” says Dr. Levine. “Breast cancer normally occurs when you’re 50 or 60, but here’s someone who develops it at the age of 30, that’s another indication.” Other indicators are people with multiple cancers. And, as Beth Karlan, M.D., director of Gynecologic Oncology at Cedars-Sinai Medical Center, points out, “your father’s family history is just as important as your mother’s.”

Of course, testing presents its own risks. Just because someone doesn’t carry a BRCA gene doesn’t mean they’ll never get cancer. The knowledge of being a carrier may cause undue stress and fear. And, in a larger context, genetic testing is so new that government hasn’t caught up, and a positive test could create insurance or employment problems. But even with pitfalls like these to navigate, knowing you’re a carrier empowers you to act, a principle message of the conference. “If you’ve been tested and you find out you’re positive, you don’t have to sit there and just feel victimized by it,” says Dr. Karlan. “You can be proactive. You can do something about it.”