B.C. initiative aims to expand genetic screening for Ashkenazi Jewish people at risk of hereditary cancers

The final gift Catriona Remocker's father gave her was discovered by a lab in a vial of his blood.

Dr. Geoffrey Remocker died of Stage IV prostate cancer in 2016, just two weeks after testing confirmed he was a carrier for genetic mutations that increase the likelihood of developing ovarian, breast, prostate and pancreatic cancers.

These hereditary BRCA1 and BRCA2 mutations are ten times more common among both men and women of Ashkenazi Jewish descent, like Remocker and her father, than non-Jewish people.

About one in 40 individuals with Ashkenazi heritage carry the mutations, according to the U.S. Centre for Disease Control, which increase the likelihood of women developing ovarian cancer, for example, from one per cent  to 30 per cent before age 70.

Both men and women are at risk, though most people know only of their links to breast and ovarian cancer.

"It's not guaranteed that you will develop cancer, but there may be a mutation in a gene that is associated with cancer that puts you at the higher risk," said Dr. Sophie Sun, co-director of B.C. Cancer's Hereditary Cancer program.

The increased risk is likely because founding members of the Ashkenazi Jewish community, in Central and Eastern Europe, had such mutations and then reproduced in relative isolation.

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But without a family history of cancer, Remocker says she was "shocked and surprised" to find out her father was a carrier, and later, that she carries the mutation as well.

"We didn't know that as people with Jewish heritage we were at increased risk," said Remocker, who co-founded non-profit BRCA in BC with her mother, Jane Remocker.

The Remockers are now teaming up with B.C. Cancer's Hereditary Cancer program to expand genetic testing for Jewish people in B.C. to save them the same shock and pain.

Ashkenazi Jewish people in B.C. qualify for free genetic testing if they have a history of cancer in their families, Sun said.

But due to genocide during the Holocaust and displacement, many people don't know they have such heritage or that their risk of certain cancers, among both men and women, are heightened.

An imminent pilot project, largely funded by Vancouver's Diamond Foundation, will study the prevalence of the BRCA mutations among Ashkenazi Jewish peoples in B.C. and aims to offer free, voluntary genetic testing to everyone with that heritage, regardless of family cancer history.

Early detection of the mutations when one is young and healthy can help avoid invasive treatments if cancer does develop and thereby save lives, said Sun.

"Some of these cancers are potentially preventable," she said.

Empowerment through early detection

Knowing she carried the gene allowed Remocker, now 39, to qualify for regular scans and take measures to reduce her risk of developing cancer, including a mastectomy to remove her breast tissue before the recommended age of 40.

"I'm a lot more empowered and I have a lot more tools to deal with it and to do something about my risk," said Remocker. "It was really hard watching my dad go through what he went through and that's certainly not something I want for myself."

Sun says people should get as familiar with their family histories as possible, and speak to a doctor or visit the Hereditary Cancer program website to see if they are eligible for free testing.

But raising awareness among the Jewish community in B.C. is difficult, said Remocker. There are only around 35,000 Jewish people in B.C, according to a 2019 estimate from the Jewish Federations of North America, and Remocker says they are more "fragmented" than in other cities with more established Jewish communities and dedicated hospitals.

Remocker hopes spreading the word will ensure others can make the decision to get tested for the mutations without having to lose a loved one.

She said that it was "really important that we start to develop more of a voice for Jewish people in the province around these health issues."