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BRCA Gene Testing And Treatment Options

Question:
לכבוד מורנו הגאב׳ד ורבנים המכובדים שליט״א

About 1 in 40 individuals of Ashkenazi Jewish descent will have a BRCA mutation, regardless of family or personal history of cancer (around 10X higher incidence than the general population). Women who are BRCA carriers have a significantly increased risk (susceptibility) for breast and ovarian cancer- up to 87% chance for breast and up to 44% for ovarian- especially at a young age (The general population risk for breast cancer is 12% and the general population risk for ovarian cancer is 1-2%).

Screening for breast cancer in risk women through mammograms and breast MRI biannually is effective in detecting breast cancer at an early and treatable stage. Screening for ovarian cancer is not effective at detecting ovarian cancer at an early and treatable stage. If there is a family history of cancer, and the results of genetic testing is normal, there is still a high risk for cancer simply because of the family history.

BRCA positive women have options to significantly reduce their risk of developing cancer, including preventive drug therapy and ‘prophylactic’ surgeries (bilateral mastectomy which can reduce risk by 90% and/or salpingo-oophorectomy which can reduce risk of both breast and ovarian cancer but is also not 100% effective).

In view of the above,

1. Does an unmarried girl whose mother with breast cancer has been confirmed to carry the BRCA1 or 2 gene have a halachic responsibility to have herself screened for BRCA gene or not?
2. An unmarried women who is confirmed to be BRCA gene positive on testing: is she halachically permitted to undergo ‘prophylactic’ mastectomy or oophorectomy should she wish to do so?
3. Is there a halachic difference if in 1 and 2 if the women has children (boy and girl) or not?

א.כ
Answer:

1. Testing of this nature is totally permissible, but not obligated according to halacha.

2. According to the strict letter of the law this would be permissible, as she is doing so to avoid a life threatening illness. However, although she is not commanded per say in the mitzvah of Pru U’rvu, she should certainly be encouraged to marry and attempt to bring a family in to the world before undergoing this procedure. Chazal indicate in many places that this is the Ratzon Hatorah that all be involved in bringing children in to the world.

3. Once one has fulfilled Pru U’rvu there is more reason to go ahead with such a procedure, yet this is not a precise halachic criteria. Rather they should be guided by this goal along with competent medical and halachic guidance.

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