Doctors panel addresses Ashkenazic cancer concerns

A medical panel agrees that while Ashkenazic Jewish women may be more susceptible to breast and ovarian cancer, better treatment offers them considerable hope.

Experts from the M.D. Anderson Cancer Center at the University of Texas in Houston confirmed the widely reported cancer statistics before some 400 women at a Hadassah conference in Burlingame Saturday of last week.

"The message…is one of very genuine hope," said Dr. Robert Bast, one of the nation's best-known clinical cancer researchers and head of M.D. Anderson's Division of Medicine.

"We are making real progress in terms of understanding the disease, detecting it early, determining those people at greater risk and developing less toxic and disfiguring treatments," Bast said.

The western region spring conference at the San Francisco Airport Marriott was dedicated to issues affecting women's bodies, minds and spirits.

One in 100 Ashkenazic Jewish women carries a gene mutation, BRCA1, which could predispose her to developing cancer, as opposed to only one in 800 among non-Jewish white women. Those who inherit an abnormal BRCA1 gene have an 80 percent risk of developing breast cancer and a 60 percent chance of developing ovarian cancer by age 70.

Even more important, a cancer diagnosis is not necessarily a death knell, the luncheon guests were assured. Early-stage cancer, the panelists reminded them, is 95 percent curable.

The panelists delivered two-plus hours of lecture, illustrated with graphic slides of breast cancer surgery and postsurgical reconstruction. A question-and-answer session followed.

Dr. Charles A. LeMaistre, president of the M.D. Anderson Cancer Center, one of the world's largest and most renowned for patient care, research, and prevention, voiced gratitude for Hadassah's longstanding support.

LeMaistre also urged that women be provided with as much medical information as possible so that they can make informed choices about cancer prevention and treatment.

Panelist Dr. Merrick Ross, an oncological surgeon, said contemporary surgical approaches to breast cancer are less invasive than in the past. Breast conservation surgery, through lumpectomy coupled with radiation therapy, is as effective as mastectomy in many patients, he said.

Most breast cancer surgery is now done on an outpatient basis, he added.

Great strides have also been made in breast reconstruction, said plastic surgeon Dr. Stephen Kroll.

"A mastectomy is a mutilating operation," Kroll said. Reconstructive surgery, he said, "eliminates the pain of having to look in the mirror every day and be reminded that you've had breast cancer."

Breast reconstruction "is not just cosmetic surgery," Kroll added. It restores a missing body part and grants a woman more freedom of activity and a better self-image.

More than ever, Kroll added, women today are opting for immediate reconstruction using body tissues and a skin flap from the lower abdomen, thus reducing donor site muscle loss and improving aesthetic results.

"They go to sleep [for the mastectomy] and when they wake up the reconstruction is mostly finished," Kroll said.

Kroll predicted that elective mastectomy coupled with breast reconstruction may become more common among carriers of the BRCA1 gene.

"I think we're going to see more and more of this in the future," he said.

Meanwhile, Dr. David Gershenson told those concerned about genetic predisposition to ovarian cancer that the disease is "very curable" in its early stages.

Trials are under way to combine blood testing with transvaginal sonography to determine whether an effective screening strategy can be developed, he said.

"We are continuing to search for more effective therapies" for advanced-stage ovarian cancer, he said.

Testing for BRCA1 and BRCA2 genes is available but expensive, initially costing between about $1,200 to $1,500. If an abnormal gene is identified, additional testing runs about $150 per family member.

However, audience members were not advised to run out for testing. The physicians cautioned that only 70 percent of abnormalities in BRCA1 can be detected using current techniques. A negative test result cannot assure that breast or ovarian cancer is not familial and a positive test does not portend the definite onset of cancer.

Those whose families have a history of multiple breast, ovarian, uterine, prostate or colorectal cancers were strongly advised to seek genetic counseling before getting tested.

Asked whether children should be tested for the gene mutation, the panelists replied that most physicians are resistant to screening minors under the age of 18.

One woman asked whether, given a family history of cancer, the doctors would recommend preventive surgery.

But the doctors demurred, calling this a very personal decision, best made after discussion with medical specialists and genetic counselors.

Liz Harris

Liz Harris is a J. contributor. She was J.'s culture editor from 2012-2018.