Okay, we all know the phrase “The Luck of the Irish.” That’s why there’s always hope that Notre Dame University will win a football game, even when they are way behind and it’s in the fourth quarter. But let’s look at heritage a bit differently in 2013, at a time when, in cancer, patients are diagnosed earlier and, in many cases, living longer. So much is being said about genetics.
Okay, we all know the phrase “The Luck of the Irish.” That’s why there’s always hope that Notre Dame University will win a football game, even when they are way behind and it’s in the fourth quarter. But let’s look at heritage a bit differently in 2013, at a time when, in cancer, patients are diagnosed earlier and, in many cases, living longer. So much is being said about genetics. For cancer patients it’s becoming more common to look at the genetic mutations that make up the composition of your version of a cancer. That’s looking at when your body starts making defective cells that don’t die – cancer cells.
But was there something in your DNA that put you at risk for this in the first place? For example, I’ve been told, as a Jewish male, that I was at higher risk for developing chronic lymphocytic leukemia (CLL), a relatively uncommon condition. I know other Jewish men who developed Crohn’s disease. I think we’re at higher risk for that too. And, of course, you’ve heard of women being tested for the BRCA1 and BRCA2 genes, just like Angelina Jolie. Jewish woman are at higher risk for those genetic problems.
The testing for what we HAVE developing, especially in cancer, is in full swing. Our interview with Dr. Bill Wierda from MD Anderson on prognostic factors is all about that in CLL. But coming next is testing for what we are AT RISK for. There are loads of questions that come with that. For example, if, in fact, Jewish men might be at higher risk for CLL and a test showed my son that he had this pre-disposition, what would he do about it? Mastectomy wouldn’t help with this one nor many other conditions. Giving us “news we can use” to prevent a wider variety of cancers where we are at hereditary risk will be important for us in the coming years.
As I now am in my 18th year as a cancer survivor I think a lot about my three kids. The oldest is 23. What can we do to understand how genetics may affect their risk of cancer (and other illnesses) and how can we help them lower their risk or reduce the morbidity of their treatment should they be diagnosed? I don’t know the answers, just the questions and I hope smart researchers who might read this are on the case. As more of us patients live longer with cancer rather than dying in short order from it, we start asking how we can help family members avoid our journey. Some of us in the Jewish community joke whether our passion for marrying someone Jewish has set us up for genetic related illnesses. The answer in some cases is yes. And we’ve understood that for many years with genetic conditions like Tay-Sachs, a fatal condition for young children who are born with it. But are there cancers to be tested for years before they would develop? Again we have some tests and there will be more.
I am happy to be Jewish and still in love with my Jewish bride, Esther, after almost 28 years of marriage. But I also worry about passing on the seeds of illness. Maybe you will say I am making too much of this, that most cancers are not connected with heredity. But as we identify more genes like BRCA1 and 2 maybe that will be less true.
Understanding family history has always been important in medicine. Perhaps with affordable testing and clear suggestions on what to do with the information, family history will become even more important – whether you have “Jewish genes” or not.
I welcome your comments and suggestions for future programs.