Divya Talwar, BDS, MPH
In late summer, 2013, Hollywood actress Angelina Jolie, accompanied by her partner Brad Pitt, revealed at a press conference that she underwent a preventive double mastectomy due to a “faulty gene”. The “faulty gene” that led to Jolie’s difficult decision was the BRCA1 gene, and the preventive procedure reduced the risk of breast cancer from 87% to just 5%. Jolie could have kept the decision private; instead, she chose to share this news with the world, in the hope that other women would follow suit and think about their own risk of breast cancer.
While Angelina Jolie’s brave decision was vastly reported on media channels in Israel, Jewish women weighed similar decisions considering their ancestry. Jews with Ashkenazi heritage, who comprise about half the Jewish population, have a higher prevalence of the BRCA mutational gene than the general population. Simply put, they are at much higher risk than the rest of the population due to their genetic makeup. This vital information has led to a surge of genetic testing and preventive mastectomies among Jewish women with positive mutations. In fact, medical centers and oncologists have joined voices for the provision of free genetic testing screening programs for the collective good. However, such decisions face tremendous ethical, legal, cultural and social implications.
The era of genetic testing began after the completion of the Human Genomic Project in 2003, when scientists decode the entire genome of humans. Personalized genomic medicine has brought transformations in healthcare through earlier diagnosis of diseases and hereditary disorders, and thus prevention of some diseases. This movement has given birth to a new translational science called Public Health Genomics which is “a multidisciplinary field concerned with the effective and responsible translation of genome based knowledge and technologies to improve population health” (NCI). This new science has opened a door by providing prevention strategies for chronic diseases, such as BRCA genetic testing to the CDC Family Health History screening tool. These innovative practices improve existing healthcare practices.
Though there has been increased awareness among people regarding the role of genetics in human health, this process needs to be streamlined to help the general public. Currently, public health genomics interventions face various challenges in different work settings. Most healthcare professionals don’t identify genomic health counseling as a part of their job, so this burden shifts towards health educators. However, studies indicate a shortage of the health education courses and curriculum that could help health educators to develop genomic competencies. Thus, there is a need for development of healthcare educators who can address various barriers of cultural and religious nature along with ethical dilemmas.
- Epidemiology and Genomics Research. (2013). Public Health Genomics (PHG).Retrieved November 28, 2012 from http://epi.grants.cancer.gov/phg/
- The New York Times. (2013). In Israel, a push to screen for cancer gene leaves many conflicted. Retrieved November 28, 2012 from http://www.nytimes.com/2013/11/27/health/in-israel-a-push-to-screen-for-cancer-gene-leaves-many-conflicted.html?smid=fb-nytimes&WT.z_sma=HL_IIA_20131127&_r=1&
- Chen, L. S., Kwok, O. M., & Goodson, P. (2008). US health educators’ likelihood of adopting genomic competencies into health promotion. Am J Public Health. September; 98(9): 1651–1657.