BRCA Halachic and Hashkafic Overveiw
Testing and preventative treatment for BRCA, involves a number of issues both in halacha and hashkafa.
Is this form of testing and treatment a lack of Bitachon? Should one ideally just daven and hope for the best? Being that current medical knowledge has shown conclusively that one who is positive for a BRCAmutation is at a much higher risk to develop cancer, testing and taking proper measures certainly falls into the category of legitimate hishtadlus, and in no way is a lack of bitachon. While there is no obligation to test or treat accordingly, doing so does not display a diminished level of emunah or bitachon. This is especially so for one with a family history of this illness.
Prophylactic surgery involves the question of “chabala”, inflicting a wound onto one’s body. In the event that the surgery is deemed medically justified, the surgery is defined as a productive act and not destructive. As such it does not fall under this prohibition. See Igros Moshe [C”M 2:66] and Minchas Shlomo [2:86:3] who explain that even elective plastic surgery is permissible in certain cases.
The surgery to remove the ovaries and fallopian tubes [prophylactic salpingo-oophorectomy] raises the issue of “sirus”, the prohibition to render a human sterile, as described in Shulachan Aruch [Even Haezer Siman 5]. Unlike chabala, the prohibition of sirus applies to both destructive and productive acts of sirus. Nevertheless, the accepted halachic ruling is that sirus of a woman is a rabbinic prohibition in accordance with the majority of poskim [the opinion of the Vilna Gaon is that sirus isha is a Torah prohibition]. That being the case, a woman with a potentially life threatening condition would be permitted to override this prohibition to protect her health. It would be advantageous to have this procedure performed by a non Jew, which would be Amira Lakum b’Issur Drabanan and leave even more room for leniency. However, her treatment should in no way be compromised in order to use a non Jewish doctor.
Even in the absence of an issur sirus, for a married woman there is an issue of removing the possibility for a fulfillment of Pru Urvu, the mitzvah to bring a boy and girl into the world. Although technically this mitzvah is only a man’s obligation, certainly the couple must address this issue together. Being that the real concern for developing illness is in the late 30’s to early 40’s, generally the couple will have time to raise a family before preventative measures need be taken. In the event they have not yet fulfilled Pru Urvu, the question of timing would be based on various medical and halachic considerations, which would need to be judged on a personal basis.
In any event a woman considering such testing and preventative measures should certainly do so with the constant guidance of a qualified Rav, who can guide them according to halacha and Daas Torah.