As 2021 arrives, the cancer world continues to remain hopeful for breakthroughs. The good news is improved outcomes are on the rise. Considering that some cancers, such as breast and ovarian, have a Jewish genetic predisposition, a few Jewish Atlanta cancer experts from Emory University’s Winship Cancer Institute shed light on innovative advancements and new treatments in their fields.
“Breast cancer risk is higher among Jewish women, and this increased risk is largely due to the higher prevalence of BRCA1 and BRCA2 gene mutations in Ashkenazi Jews,” according to Dr. Jane Lowe Meisel, an oncologist and associate professor of hematology and medical oncology at Winship.
“To the best of our knowledge, mutations in the BRCA genes are present in about 1 in 400 people in the general American population, but in about 1 in 40 Ashkenazi Jewish men and women. It is estimated that about 8 to 10 percent of Ashkenazi Jewish women diagnosed with breast cancer in the United States have a mutation in one of these two genes. Women with a mutation in BRCA1 or BRCA2 have about a 70 percent chance of developing breast cancer over a lifetime, and on average, tend to be diagnosed at younger ages than breast cancer patients who are not mutation carriers.”
Meisel recommends “all Ashkenazi Jewish women with a family history of breast cancer to be proactive about considering genetic testing for BRCA1 and BRCA2, because knowledge is power. If you do not carry a mutation it doesn’t mean you will never get breast cancer, but it means your risk depends on other things, too, such as certain lifestyle factors and family history, of course.
“If you are found to have a mutation in BRCA1 or BRCA2, you have a higher risk of cancer, but you can also get plugged in with all the right protocols to optimize prevention,” Meisel said.
“We have a study ongoing as a collaboration between Emory and JScreen called PEACH (Program for the Evaluation of Ashkenazi Jewish Cancer Heritability) BRCA, looking at the value of genetic testing for BRCA1 and BRCA2 for Ashkenazi Jews who do not have a family history of cancer. The goal of this study is to learn more about the BRCA mutation rate for people with Ashkenazi Jewish ancestry and to optimize outcomes by learning the best ways to tie patients in with the right preventative care and treatments,” she continued.
“We have learned a great deal in recent years about risk reduction in patients with BRCA mutations – both for those who have been diagnosed with cancer and for those who carry a gene mutation but have not developed a malignancy.”
Dr. Jonathon Cohen is director of lymphoma clinical trials research at Winship. “Some cancers tend to run in Jewish families, however with blood cancers, this doesn’t appear to be quite as relevant, although we know that a family history of blood cancers like lymphoma can increase a patient’s likelihood of developing one. For lymphoma, there is no specific genetic screen or testing that we recommend for family members of affected patients. It is important that patients are aware of their family history so that they can discuss this with their primary care physician at a yearly physical exam.”
Cohen discussed treatment options. “The management of lymphomas continues to evolve with new advances coming each year, and 2020 was no exception. While traditional chemotherapy is still incorporated into the treatment for some patients, others can be managed with oral targeted agents [for example, a daily pill] that control their disease for many years. Others are candidates for a new form of immunotherapy-based treatment, including chimeric antigen receptor (CAR)-T cells, which utilize the patient’s own T-cells to attack their cancer. This type of therapy is available now for patients with relapsed aggressive non-Hodgkin lymphoma as well as some forms of leukemia, and it is being investigated in other cancer subtypes,” he said.
“At our most recent national meeting of the American Society of Hematology, there was one study reported which identified outstanding outcomes for patients with low grade non-Hodgkin lymphoma as well. Our team has been involved with the clinical development of these therapies and we have the expertise to manage patients both in the setting of clinical trials plus those patients who are receiving the treatment.”
Dr. Jonathan L. Kaufman, an associate professor and interim division director in Winship’s Department of Hematology and Medical Oncology, focuses on patient care and research in myeloma and other plasma cell disorders. He explained, “Multiple myeloma is the second most common blood cancer after lymphoma. Myeloma is cancer of the plasma cells. Plasma cells reside in the bone marrow and their normal job is to make antibodies to help prevent and fight infection. We don’t know why plasma cells turn into cancer, but we know that it is rarely hereditary. The cause is likely related to environmental factors and random events within the plasma cell. Outcomes for patients have improved dramatically over the past 20 years primarily due to new effective and safer therapies. We haven’t found a cure yet, but with technology getting better, a cure for myeloma is in our future.”
Whether you have a family history, Jewish genetic link or a non-related cancer, it’s still a family affair, according to Katie Simon, a Winship physician assistant. “My role is to manage the medical side of illness and instill confidence in my patients by addressing their needs and making them feel safe in their treatments. Family plays a large role in cancer care. And I’m using family in a broader sense – it involves community and friends – your chosen family.”
Cohen looks toward the future. “I think it is becoming increasingly clear in 2021 that there are so many ways to treat and diagnose patients, ranging from new immunotherapies to close observation. I expect the drumbeat of progress will continue in 2021 just as it has this year,” he said.
“Patients should continue to be participants in their care, ask questions about new therapies and clinical trials, and recognize that the relationship they have with their oncologist will likely be a long one with a number of turns along the way as together you manage this disease.”