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October 15, 1999/5 Cheshvan 5760, Vol. 52, No. 7
Researchers make progress in fight against breast cancer
WENDY ELLIMAN
Special to Jewish News
Fact: Every year, breast cancer attacks one in every eight Israeli women. Fact: In more than a third of those cases, the disease has spread beyond the breast by the time it is diagnosed. Fact: Within two years of diagnosis, a quarter of its victims will be dead.
"Metastatic breast cancer remains an undefeated enemy, but it's coming under tightening siege," says Professor Tamar Peretz, who heads the Sharett Institute of Oncology at the Hadassah-Hebrew University Medical Center in Jerusalem, where a quarter of all Israel's cancer patients are treated. "Years of basic and clinical research are finally bearing fruit. Where we're able to help, we help a lot. And where we can't cure, we can do much to extend a patient's life and improve its quality."
A woman's breast is more susceptible to cancer than any other organ in her body, but breast cancer's ravages are, it seems, far from indiscriminate. Breast cancer in Israel attacks, for example, 65 Jewish women compared with 17 non-Jewish women in every 1,000. Its incidence is significantly higher among Ashkenazic immigrants to the country than among newly arrived Sephardim. Jewish newcomers from Russia have the highest rate of all, while the disease is virtually unknown in the Ethiopian Jewish community. In Israeli-born Jewish women of all ethnic backgrounds, breast cancer levels approach those found among Ashkenazic newcomers.
All of which constitutes an unparalleled human laboratory, within which Israeli researchers are urgently working to learn more about the causes and prevention of this growing scourge.
The susceptibility of Ashkenazic women to breast cancer was confirmed some years back by discovery of a so-called 'cancer gene' - genetic mutations known as BRCA1 and BRCA2, which bestow an unwelcome 90 percent lifetime risk of developing breast cancer. Professor Nadine Cohen-Elbaz of the Technion's Tamkin Molecular Human Genetics Research Facility estimates that 5 percent to 10 percent of women diagnosed with breast cancer each year have a family history of the disease, with around 45 percent of them carrying a BRCA mutation. In a unique multidisciplinary study involving clinical geneticists, oncologists, psychologists, epidemiologists and a philosopher, she is screening families of different ethnic backgrounds to identify common gene mutations, and studying their medical histories, diet and lifestyle. The aim is to identify environmental and lifestyle factors that may contribute to development of the disease.
One of her early findings is that breast cancer is 50 percent less common among Arab women in Israel than their Jewish sisters. Professor Eliezer Robinson of the Technion's Faculty of Medicine, who lost his mother to breast cancer, has observed that while the disease is far rarer among Israeli Arab women, it tends to surface among them at younger ages, metastasize more vigorously and offer far shorter survival.
To explain these differences, Robinson has been looking at nutrition, genetics, lifestyle and socio-economics, and one area of his research which seems, quite literally, to be bearing fruit is diet. Arab women generally eat far more fruit and vegetables.
"Evidence suggests that a population which eats a lot of cruciferous vegetables, such as cabbage, broccoli and radishes, has a lower incidence of breast cancer," says Professor Shmuel Yanai of the Technion's Faculty of Food Engineering & Biotechnology. With Gad Rennert of the medical faculty and two physicians from Hebrew University, he has isolated what he believes is a protective substance from these vegetables. Tests run on kibbutz volunteers have supported these early results.
Vegetables, specifically tomatoes, are the focus of studies by Michael Koretz, director of the Elisheva Eshkol Breast Health Center at the Ben-Gurion University of the Negev.
"Epidemiological data show lower incidence of breast cancer among women who eat a lot of tomatoes," he says. Together with endocrinologist Yossi Levy, he has isolated from tomatoes what may be a preventive substance called lycopene, and he is now studying its absorption into body tissues.
At the laboratory bench in Hadassah, researchers are trying to stimulate the body's own immune system into fighting the cancer - urging its cells to defend themselves in what they call immunotherapy. They are also examining the mechanism of tumor metastasis, and looking for ways to block that mechanism.
While the search for protection and prevention continues, early detection and speedy treatment still offer women the best chance of survival. As Koretz reminds us, "cancer is a disease that's highly treatable, if caught early."
Despite this, however, fewer than half of Israeli women age 50 and more go for mammograms.
"It's women with a Western perception of health and a Western belief in the power and correctness of medical intervention who tend to seek mammography," says Professor Lea Baider, psycho-oncologist at the Hadassah Medical Center. "Among Arab, Beduin and certain ultra-Orthodox Jewish communities, for example, pain and body changes are regarded as normal. Neither is a reason to run to a doctor."
In two of every three instances, they are right. Only one in three breast lumps is, in fact, malignant, but it takes a biopsy to find out - though this may now be changing.
Researchers at the Weizmann Institute of Science in Rehovot have pioneered a non-invasive way of identifying breast tumors, which they call 3TP. Developed by Prof. Hadassa Degani of the Biological Regulation Department, together with radiologists from Hadassah, their method consists of injecting a dye into the patient's blood stream and monitoring how it is taken up and cleared by tumor tissue, using magnetic resonance imaging or MRI.
"Malignant and benign growths deal with the dye in strikingly different ways, so this approach can markedly reduce the number of biopsies performed to diagnose tumors," says Degani.
As well as diagnosing breast tumors, the Weizmann method may help establish the prognosis of the cancer by revealing the network of blood vessels that feed the tumor, and it may also monitor the effectiveness of therapy by visualizing these blood vessels and the spaces between them.
And what of the 2.9 million women in Israel who, despite all efforts, are today fighting breast cancer?
Treatment provided in Israel is on a level with the best in the world, from painless removal of breast lumps by computerized mammographic guidance (ABBI) at the Ben-Gurion University's Breast Health Center, through surgery and breast reconstruction, aggressive adjuvant therapy (radio-, chemo- and hormonal) and, in women with advanced disease who have a 95 percent chance of relapse, polychemotherapy followed by bone-marrow transplantation.
"With adjuvant therapy, we can reduce the number of women in whom the disease will recur by one third," says Peretz of Hadassah. "Bone marrow transplantation can cure a doomed patient. Overall breast cancer survival during the past 40 years has climbed steadily from one in three to one in every two women."
Despite the improving figures, breast cancer remains a devastating illness.
"Psycho-social support is a key element in the service we provide," says Koretz of the Ben-Gurion University Breast Health Center. "We have both qualified professionals and peer-support empowerment groups to help patients cope."
At Hadassah, the psycho-oncology team led by Baider researches extensively on the impact of family support, the marriage bond, a personal belief system and earlier life-traumas on the coping ability of a patient and her family. It also teaches relaxation techniques.
Israel's ethnic kaleidoscope of women share the unhappy distinction of one of the world's highest rates of breast cancer. Whether the ultimate answer lies with cellular warfare, eating more vegetables or with something not yet stumbled on, they may yet share the prize of comprising the human laboratory in which the disease finally meets its defeat.
This story is part of a series of feature articles on medical, scientific and technological developments in Israel. The articles are put together by Hadassah, the Women's Zionist Organization of America, American Society for Technion, American Committee for the Weizmann Institute of Science; and American Associates of Ben-Gurion University of the Negev, and are being provided to Jewish Telegraphic Agency newspaper clients.
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