The Health Ministry said Tuesday that thousands of women who received counseling by a leading genetics expert may not have undergone all the tests necessary to determine whether they are carriers of the mutation that puts them at high risk of breast or ovarian cancer.
The ministry has instructed the health maintenance organizations that referred patients to Prof. Zvi Borochowitz for genetic counseling when they had a family history of breast cancer or ovarian cancer to locate these women so they can undergo all the necessary tests. Until three years ago Borochowitz headed the Bnei Zion genetics institute in Haifa.
The ministry said some of the women who were referred to Borochowitz may need lab tests to detect the genes that increase the risk of breast and ovarian cancer – BRCA 1 or BRCA 2. The ministry said that most of the women are from the north, and were referred by the Maccabi, Meuhedet or Leumit HMOs.
Despite the concern, there is no indication that there are thousands of cases of cancer that were missed without the women developing the related symptoms, or that there are women who did not know they were in the high-risk group.
But even if the group is smaller, genetic testing provides a reliable prediction that might lead to a preventive mastectomy or removal of the ovaries that saves the lives of many women.
According to the Health Ministry, Borochowitz did not send patients defined as high-risk for genetic testing to determine whether they had inherited the genes. The ministry based its claim on lawsuits filed by two of Borochowitz’s former patients and an investigation it recently conducted.
Borochowitz is said to have counseled thousands of women both through the public medical system and privately.
A statement issued in Borochowitz’s name said that from 2004 to 2006, he counseled a few dozen women about breast cancer and ovarian cancer. “In the framework of the counseling, he would, based on his best medical judgment and in keeping with a circular from the Health Ministry on the matter, determine the cases in which he would recommend to women to undergo testing for the gene mutations BRCA 1–2.”
The statement said that at the time he was heading the only genetics institute in the north that carried out testing privately, “and therefore he was even more careful [about avoiding] an ethical failure by referring patients to private testing that had no clear or unambiguous justification.”
The statement said that beginning in 2006 “after court rulings that had no connection to his work, the approach changed and patients were also offered the option of undergoing tests privately that were not included in the health basket,” referring to the medications, procedures and services covered by the state.
The Bnei Zion Medical Center said in response: “Prof. Borochowitz stopped working at the hospital three years ago. Beyond this, we are working based on the Health Ministry’s instructions.”
In 2004, the state began paying for the test for which the Health Ministry says Borochowitz did not send women at high risk for breast cancer or ovarian cancer. Before then, many women paid for the test themselves.
Around 10 to 15 percent of cases of breast cancer and ovarian cancer are hereditary. Since women who carry the mutation are at higher risk of contracting the cancer, genetic testing via a blood test is a life-saving tool.
According to the Health Ministry, the test is performed on the recommendation of a genetic specialist after the patient has received genetic counseling and if she belongs to a population group in which the rate of mutation carriers is 1 percent or more, or when the women has a first- or second-degree relative who has had breast cancer or ovarian cancer.
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