In 2013 Angelina Jolie penned an impassioned Op-Ed about her risk of breast cancer and treatment plan. Jolie’s grandmother, mother and aunt all died from breast and ovarian cancers and like her relatives, she carried a mutated BRCA gene – a gene that everyone (male and female) carries, but when mutated, increases the risk of breast and ovarian cancer. She wrote about her decision to get tested and later explained why she chose her particularly aggressive course of treatment, arguing that it’s a deeply personal choice and needs to be made only after thorough medical consultation. She certainly got people talking. There was a sudden increase in women being tested for BRCA, since after all, doesn’t it make sense for everybody just to get tested anyway?
But for us, we want to know the Jewish view, particularly since Ashkenazi Jews are known to have a higher prevalence of BRCA mutations than the general population. From the strict halakhic perspective, of course there is no problem with performing the actual test – it’s a simple blood draw similar to a routine doctor’s visit. But even though it’s permissible, it doesn’t automatically mean that it’s wise. Most women who get tested aren’t actually sick. A positive BRCA test is a single component in calculating the risk of a future disease – something that doesn’t yet exist.
Doesn’t the Torah frown upon trying to predict the future, whether through fortune telling or even more conventional methods? Isn’t genetic testing just a way of looking in a modern ‘crystal ball,’ which the Torah seems to reject? In a similar context, Rav Moshe Feinstein points out that nobody has a problem with looking both ways before crossing a street. We don’t just cross when there aren’t any cars in front of us right now, since there may very well be a car speeding in our direction. Rav Feinstein explains this certainly doesn’t violate the prohibition of trying to predict the future, since it’s our responsibility to keep our eyes open and act in response to what we see. The same thing is true, he explains, with genetic testing. Although we can’t see our DNA, since it is so easily analyzed, it’s as if the results are right in front of us. To act as if they don’t exist would be like crossing the street while closing our eyes.
But having information isn’t helpful without an understanding of what it means. Information doesn’t always correlate with knowledge. Testing provides information that makes sense to perform when the results provide information that can lead to knowledge. About 12% of all women will develop breast cancer before age 70, while the likelihood for a woman with a mutated BRCA gene is about 4-5 times that. But even then, breast cancers attributable to hereditary factors comprise only about 5-10% of total cases. So although a woman’s cancer risk nearly doubles if she has a first-degree relative diagnosed with breast cancer, less than 15% of women with breast cancer have a family member diagnosed with it.
In other words, it’s complicated. No single test gives a complete picture. Many factors play a role and even then, only generate a statistical likelihood of developing cancer and cannot definitively answer whether or when a particular woman will develop breast or ovarian cancer. A genetic test is just one piece of information in a larger, highly individualistic healthcare puzzle. Obtaining genetic information isn’t enough – it’s what the data means that is important.
What will I do with the information? Will a negative test give me a false sense of assurance that I will never get breast cancer? If positive, should I be more vigilant about screening or should I opt for something far more radical? All of these are good questions; questions that can’t be answered with a simple genetic test.
That’s why our greatest Poskim have always advocated for each person to discuss her risks with her physicians and together to come to a decision about whether or not to test. What to do about it moving forward is separate question that needs to be discussed with a competent and compassionate medical professional. There are a lot of options available, ranging from watchful waiting, to vigilant testing, to prophylactic medications, to far more invasive procedures. (See here for some Jewish perspectives.)
When thinking about the larger picture, some view this as challenging God’s plan for the world. Who are we to attempt to control our futures? Chazal teach us that this is the wrong approach. When creating the world, God specifically chose wheat to grow from the ground, not bread; he left that for us. When we bake bread we take natural raw materials and apply our knowledge and skill to produce something delicious and [hopefully] nutritious. God created the world in such a way that he leaves it up to us to perfect it; it’s what He wants and expects from us. When we use our knowledge, insights, and skills to unlock the secrets of nature to help secure and protect our health – we aren’t challenging God in any way. On the contrary, we are partnering with Him to make our world a better place.