IMAJ | volume 25
Journal 1, January 2023
Variations in Practice and Geographic Disparities Between Dedicated Multidisciplinary Clinics for BRCA1/BRCA2 Mutation Carriers in Israel
- Naama Hermann ,
- Pnina Mor ,
- Orit Kaidar-Person,
- Rinat Bernstein-Molho,
- Mali Brodsky ,
- Dana Madorsky Feldman,
- Anath Flugelman ,
- Hadar Aboody Nevo,
- Danna Meshoulam Avital,
- Miri Sklair-Levy,
- Eitan Friedman ,
- Tanir Allweis
1 Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
2 Breast Radiation Unit, Oncology Institute, Sheba Medical Center, Tel Hashomer, Israel
3 Levy Gertner Oncogenetics Unit, Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
4 Meirav High Risk Clinic, Sheba Medical Center, Tel Hashomer, Israel
5 Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel
6 Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
7 Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
8 Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
9 BRCA Clinic, Rambam Health Care Campus, Haifa, Israel
10 Rappaport Faculty of Medicine, Technion–Institute of Technology, Haifa, Israel
11 Department of Surgery A, Emek Medical Center, Afula, Israel
12 Nitzan Breast Clinic, Ramat Yishai, Israel
13 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Population screening for the BRCA
mutations in Ashkenazi Jewish women was recently implemented in Israel and is expected to lead to a 10-fold increase in the diagnosis of asymptomatic carriers. Performing the screening follow-up within multidisciplinary dedicated clinics for carriers is recommended for early detection and risk reduction.
To determine the availability, capacity, and practices of dedicated screening clinic for BRCA
carriers in Israel.
A telephone-based survey of all public hospitals in Israel was conducted October 2020 to August 2021 to determine whether they had a dedicated clinic. Dedicated clinics were defined as multidisciplinary screening clinics offering at least breast and gynecological screening and risk reducing services on site. The clinic director or nurse navigator answered a questionnaire about screening practices followed by a semi-structured interview.
Results: Of the ten dedicated BRCA clinics found in Israel, nine participated. Approximately 4500 BRCA carriers are currently being followed. No specialized clinics are available in the southern district or in the northernmost half of the northern district of Israel, leading to a disparity between periphery and center. Screening recommendations, although asserted as adhering to international guidelines, vary among clinics including age at initiating of clinical exam, use of adjunct imaging modalities, and follow-up during lactation and after risk reducing surgery.
There is a suboptimal distribution of dedicated clinics for BRCA
carriers in Israel. Nationally centralized attempt to create guidelines that will unify screening practices is warranted, especially considering the expected increase in demand.