From Research to Patient Care
Hadassah has a great tradition of bringing scientific knowledge directly from the laboratory to the bedside. During a visit to Hadassah House, Prof. Tamar Peretz, Director of HMO’s Sharett Institute of Oncology, spoke about the vitally important research her Institute is engaged in and how patient care in the Sarah Wetsman Davidson Tower will be affected by it. She focused on research being done on the BRCA gene and breast cancer.
Prof. Peretz said the Sharett Institute of Oncology is unique because all five of its components - the oncology clinic, the ambulatory treatment unit (outpatient care), the inpatient care department, the radiotherapy unit and the research unit - are under one roof and the personnel all work together as one team. This kind of cross-pollination means that each area is informed by the work of other areas and the ultimate result is improved patient care, she explained.
Prof. Peretz spoke about the research the Sharett Institute has done with the BRCA gene, which is one cause of breast cancer. The BRCA gene test is a blood test to check for mutations in genes that help control normal cell growth. Finding changes in these genes, called BRCA1 and BRCA2, can help determine a person’s likelihood of developing breast cancer and ovarian cancer. A BRCA gene test does not test for cancer itself, and the test is usually only done for people with a personal of strong family history of breast cancer or ovarian cancer. Genetic counseling before and after a BRCA test is vitally important for the patient to understand the benefits, risks, and possible outcomes of the test.
“Hadassah has 5,000 men and women in a genetic counseling program,” Dr. Peretz said. “About 1,000 are carriers of the gene for breast cancer. We have 20 pairs of mothers and daughters who are carriers. In some cases, the daughters are sick and the mothers are healthy even though their genetic profile is the same.”
The challenge to researchers was to determine what was in the women’s environment that made these younger women sick. The next challenge was how to use the information uncovered by the research to improve patient care.
The initial results of the research suggest that one major player may be hormones. Many of the younger women began using contraceptives at a young age (18 to 20) and so had elevated levels of hormones in their systems. There also are other hormones in the environment that didn’t exist years ago.
Other risk factors are being underweight (for pre-menopausal women) and overweight (for post-menopausal women). However, identifying risk factors can be very complicated, Dr. Peretz said, because it is so difficult to isolate diet or weight as a separate factor from physical activity. In addition, other lifestyle factors, such as sleep, may play a greater role than suspected previously.
All of this research plays a role in patient care in terms of counseling about lifestyle choices and genetic testing. There is a test for the BRCA gene, but should all women be given the test?
“The test is important only if it has an impact,” Dr. Peretz commented. “I would recommend genetic testing depending on the circumstances. For example, now we recommend an MRI of the breast to women with cancer in their families. This test should be done about ten years before the onset of disease in the person’s relatives. But if there is no cancer in the family, should it be done?”
“The BRCA 1 gene has numerous mutations,” Dr. Peretz continued. “Hadassah did not identify the BRCA gene, but has studied the mutations.”
Specifically, Hadassah researchers have studied the frequency of occurrence in the Jewish population. The researchers have found that the BRCA 1 gene occurs about ten times more frequently in the Jewish population than in the non-Jewish population. Increased testing and counseling may be two results of the research, and new treatments also may grow out of these studies.
The goal of the Sarah Wetsman Davidson Tower is to give the people of Jerusalem and Israel an inpatient facility that combines the most advanced medical technologies with a deeply compassionate approach to healing. The breadth and variety of research at HMO ensures that the Tower’s patients will receive the best care available anywhere in the world.
You can support Hadassah’s work with Breast Cancer by making a gift of any amount to Hadassah. A few suggestions are:
– cost of a One Bed Intensive Care Unit in Oncology