Chai Cancer Care
TURNING THE TABLES ON CANCER DIAGNOSIS Professor Ranjit Manchanda’s work has led to the NHS Jewish BRCA Testing Programme. It has life-changing significance for the Jewish community – and for the population as a whole
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aiting until you have cancer is no way to protect a population from getting it. Traditionally, genetic testing to identify BRCA carriers, has involved accessing high-risk cancer genetics clinics or regional genetics services. The criteria have always been based on having a strong family history of cancer or fulfilling standardised clinical criteria. It’s a complex testing process and can vary regionally and internationally.
Screening trials are available for prostate cancer in men and for pancreatic cancer, too. Lifestyle, contraceptive and reproductive choices can also impact cancer risk and help a couple plan a family. For instance, an IVF approach called preimplantation genetic diagnosis (PGD) allows a fertilised embryo’s DNA to be tested outside the body, to ensure the transmission of the faulty gene is not passed to the next generation.
Would you be surprised to learn that around 60% of BRCA carriers do not even qualify for the family history-based genetic-testing criteria and are missed? And that roughly 90% of Jewish BRCA carriers in the UK remain unidentified despite 25 years of genetic testing across the NHS? That is why, in my opinion, the current approach – identifying a BRCA carrier after a cancer diagnosis is, arguably, a failure of cancer prevention.
The opportunity (Jewish) BRCA population testing offers, irrespective of family history, cannot be underestimated. It has been the focus of my research since 2007 and I’ve worked in close cooperation with a large number of Jewish charities, stakeholders, rabbis, religious leaders, and community organisations. Research from our trial so far shows a high uptake of the BRCA-testing opportunity across all parts of the community.
With the occurrence of potentially preventable BRCA-associated ovarian and breast cancers 2.5 times greater in the Jewish population than in the wider population, gene testing in the Jewish population can have a major impact in the goal of stopping cancers from developing.
The test can be delivered in a community setting and delivered to homes, making access to it easy, and helping to reduce long-term anxiety and uncertainty. Most importantly, it will more than double the number of BRCA carriers identified. Dare I say, it also saves money for the NHS. There aren’t many interventions in healthcare that save both lives and money, but BRCA population testing in the Jewish community is one of them.
There are clear and effective management options for people who have a positive result. For breast cancer these include risk reducing surgery (mastectomy), medical prevention and intensive annual screening with MRIs or mammograms. The removal of the ovaries and fallopian tubes after a family is complete, can prevent ovarian cancer.
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Currently, Israel’s BRCA-testing policy includes Jewish women only. England’s Jewish population is only the second worldwide to undergo population-based genetic testing in a clinical/healthcare setting. It offers a huge opportunity, and I hope the programme will lead to this strategy being incorporated as routine. The Jewish population is an exemplar for others to follow. Indeed, the evidence emerging from the BRCA study has in
large part helped my team receive funding for a research study testing cancer genes in the general population (called PROTECT-C) starting later this year. A huge step forward.
The NHS England Jewish BRCA Testing Programme • The programme will launch early in 2024 • The saliva test will be free to anyone with at least one Jewish grandparent • You must be aged 18 or over • Speak to an NHS genetic counsellor to ask any questions via a dedicated helpline: 020 3437 6001 Mon, Tues, Thurs, Fri 9am-5pm; Weds 9am-7pm • For more information, or to register visit jewishbrca.org
Chai services • BRCA Support Group for those without cancer • BRCA Support Group for cancer patients • Individual, Couples or Family Counselling for genetic-related issues For more details email Charlotte Hildebrand on charlotteh@chaicancercare.org or call 020 8457 3238
Ranjit Manchanda is a Professor at Wolfson Institute of Population Health, Barts CRUK Cancer Centre, Queen Mary University, London, and Consultant Gynaecological Oncologist at Barts and the Royal London Hospital, London. Among many roles, he specialises in populationbased testing, risk prediction, targeted screening, and cancer prevention.