The Jewish population in the Chicago metro area is among the largest in the United States after New York, Los Angeles and Miami, according to Brandeis University’s American Jewish Population Project. With this in mind, City of Hope® Cancer Care North Shore in Morton Grove, which neighbors Skokie where the Jewish population is estimated at nearly 30%, is carefully attuned to the elevated cancer risks certain Jews face.
Those of eastern or central European descent — known as Ashkenazi Jews — make up about two-thirds of all American Jews. As opposed to Sephardic Jews — whose ancestors came from the Middle East, North Africa or Spain — Ashkenazi Jews have been found to have genetic mutations that elevate their risk for developing a variety of cancer types.
“No one really knows exactly why, but it’s likely that when the Jewish nation was in Europe, there were moments in history where they were forced to live in very insular communities, so-called ghettos,” explains Marlon Kleinman, M.D., a hematologist-oncologist at City of Hope North Shore. “They didn't travel out, so those who were somewhat closely related would marry each other in that setting. It would be prohibited for siblings, but first cousins would often get married, and so whatever gene mutations evolved had the opportunity to continue.”
These ancestral gene mutations likely have been passed down through the generations making today’s Ashkenazi Jewish community potentially at a higher cancer risk.
- Ashkenazi Jews and Cancer Risk
- Ashkenazi Jewish Genetic Traits
- Why Do Doctors Ask if You Are Ashkenazi?
- Managing Cancer Risk in the Midwest
If you or a loved one has been diagnosed with cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.
Ashkenazi Jews and Cancer Risk
Dr. Kleinman explains that these gene mutations are known as germ mutations, which occur at the moment of conception.
“So, when a sperm and egg come together, there's some pre-existing change in the software of what makes that person that person,” Dr. Kleinman says. “And every single cell in the entire body bears those mutations or that mutation.”
This is important because existing gene mutations may be identified in people through genetic testing, which may help inform their medical care to help prevent cancer, among other benefits.
Germ mutations are different from somatic genetic changes, which are acquired after birth and are due to exposures during a person’s life, including environmental factors, dietary habits or behaviors, for instance.
For Ashkenazi Jews, some of the more commonly identified mutations increase the risk for developing ovarian cancer in women, prostate cancer in men, colon cancer, pancreatic cancer and breast cancer in both men and women.
Other cancers and health conditions, including Gaucher Disease, Tay-Sachs Disease and Crohn’s Disease, have also been linked to genetic mutations often found in the Jewish community. A comprehensive list of conditions affecting Ashkenazi and Sephardic Jews is available on the Mazor website, which offers information on many aspects of Jewish life.
Ashkenazi Jewish Genetic Traits
Mutations to the BRCA1 and BRCA2 genes are perhaps the most well-known of those affecting the Ashkenazi Jewish community. These genes work to help control cell growth and fix DNA errors. When a mutation in these genes occurs, they may not be able to control cell growth, possibly leading to tumors.
While it is estimated that 1 in up to 800 people in the general population carry a BRCA1 or BRCA2 mutation, for Ashkenazi Jews the statistics show 1 in 40 individuals carry the mutation.
“BRCA is sort of like the classic gene mutation in the Ashkenazi community,” Dr. Kleinman says.
That translates to a 60% probability of a woman with the mutation developing breast cancer compared to a 13% chance among those in the general population without the mutation.
Up to 26% of men with a BRCA1 mutation and 61% with a BRCA2 mutation will develop prostate cancer by age 80, compared to 10.6% in the general population.
Recent research also shows that 5% of people with a BRCA1 mutation and up to 10% with a BRCA2 mutation will develop pancreatic cancer, compared to 1.7% in the general population. In addition, those with the mutation may develop pancreatic cancer at an earlier age than those without the mutation.
Why Do Doctors Ask if You Are Ashkenazi?
With this knowledge in hand, doctors may ask about a patient’s Jewish heritage to help gauge his or her cancer risk. They likely will ask about family history of cancer and perhaps recommend genetic testing and/or counseling to determine whether they carry specific gene mutations, which may help them assess cancer risk.
This information will help when considering type and frequency of screening tests to help identify any changes or warning signs early.
“It is somewhat dependent on what the mutation is,” says Dr. Kleinman. “There are guidelines and various consensus bodies that are developing and continue to develop what that should look like in terms of screening.”
Doctors may recommend screening tests more frequently for those with gene mutations that elevate risk, Dr. Kleinman says.
“Screening mammography is beneficial and enough for a general population, and an annual mammogram is still done in a BRCA patient, but we tend to also include MRI of the breasts, as well,” he says. “We alternate screening mammography — and, depending on the density of the breasts, we may use other radiological modalities — with an MRI of the breast six months later. So, every six months it's one or the other and this is juxtaposed with physician examinations and self-breast awareness.”
Ovarian cancer is a “little more tricky to identify,” Dr. Kleinman says. For men with an elevated risk for developing prostate cancer, starting PSA tests and digital rectal exams at an earlier age may be appropriate.
“There is less developed screening [protocols] for pancreatic cancer,” he says. “We've seen a rash of pancreatic cancer in this population. So, we’ve been doing endoscopic ultrasound, plus or minus some sort of MRI-related testing on a regular basis, whether annually or a little less than annually — there’s debate on all that.”
Managing Cancer Risk in the Midwest
Knowing that a large percentage of the population in the Chicago area is of Jewish heritage, City of Hope offers genetic screening, testing and counseling. And doctors like Dr. Kleinman are alert to elevated risk factors associated with family history when meeting with patients.
Jewish organizations in the Chicago area and nationally are working to help raise awareness among the Jewish community as well as the general population about genetic mutations that elevate cancer risk.
“It would be very important to be all-inclusive somehow,” Dr. Kleinman notes. “Even if someone's unsure of their descent, maybe, you know, their great-grandmother was in a ghetto or was an Ashkenazi Jew, but there may have been intermarriages along the path. Although that person may have no idea or no sense of belonging to the Ashkenazi community, they may still have Ashkenazi in them.”
If you or a loved one has been diagnosed with cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.