Towards a Better Life: Tennis and Gene Testing

Up to the age of forty- four Rose Dembitzer, the beautiful and accomplished granddaughter of Holocaust survivors who settled in Costa Rica, seemed to live a charmed life. As a young adult she relocated to study in the States, found work in the New York branch of Israel's Discount Bank, married a handsome, successful, tremendous Zionist whose mother is Israeli, and periodically considered, and rejected, making aliyah. After staying home for a few years with her two young children, Rose went back to school for an MA in Environmental Planning and became a sustainable consultant in green buildings. She and husband Alex, a real-estate businessman, were living the dream. Then, in a move that might ultimately save the lives of many Israelis, they decided to make Israel their home.

The Dembitzer's family initial integration into their new country could be a poster-story for successful aliyah. Husband Alex soon found work in the field of renewable energy, son Jacob flourished in his new High School, and a stunning home near Tel Aviv made settling down in Israel seem sweet.

Rose, a keen tennis player, looked around for something to enjoy while learning Hebrew. Almost immediately, in conjunction with the Israel Tennis Center, she put a program in place to develop her sport among girls. The aim of the program is not to create champions, but rather to teach leadership, boost decision making and public speaking skills, and to elevate women's sport in Israel. Graduates of the program can go on to become sports broadcasters or psychologists, coaches and physiotherapists, having acquired tools to ensure success in work and in life.

Everything was falling into place; Rose was thrilled with her new life. And then disaster struck. A routine mammogram revealed a lump in her breast, a needle biopsy confirmed cancer, a lumpectomy was followed by a course of treatment. The chance remark of a friend abroad – "Did you get that Jew-gene test?" – led to a screening for the BRCA gene mutation; Dembitzer tested positive. "I knew nothing about this gene," she explains, "but I did the research." Thanks to Angelina Jolie, today the facts and figures of the BRCA gene are more accessible; a few years ago there was less awareness. BRCA 1 and BRCA 2 gene mutations carry different risk factors; both substantially raise the lifetime chances of developing breast cancer to 60-80%, and carriers have an elevated (30-45%) lifetime risk of ovarian cancer as well. Both men and women carriers have a tiny increased risk of pancreatic cancer and melanoma, and men have an elevated risk of prostate cancer. (Male carriers are also at greater risk of breast cancer, although the chances are still small.)

Knowledge is power: armed with the facts about the gene, women undergo regular screenings. MRIs, mammograms and ultrasounds are all covered by Israel's health services for those who test positive for the mutation. Early detection of breast cancer greatly enhances the chances of successful surgery or other treatment. Ovarian cancer is hard to detect early, but carriers can be proactive: ovaries can be safely and easily removed as soon as childbirth is over. A double mastectomy alleviates all fear of breast cancer; women can consult with their doctors about that option.

Dembitzer decided to go for the surgery. And then life took over. "My doctor at Memorial Sloane Kettering unexpectedly postponed my mastectomy for two weeks," she explains, "so I decided to remove my ovaries and fallopian tubes in the interim." The only available slot was on a big holiday weekend. As her CA 125 test had been normal a year before, and an ultrasound showed that everything was clear, Rose's family urged her to postpone the operation, but a 'strong feeling' compelled her to go ahead. It was lucky that she did.

A biopsy revealed ovarian cancer, necessitating yet more surgery. A radical hysterectomy was followed by a bout of harsh chemotherapy that left her battered and aching. But Dembitzer's ordeal wasn't over yet. After a three month recovery period she opted for a double mastectomy, to reduce the risk of more cancer.

Hit with two bouts of cancer in less than three years, many women might understandably spend some pampering time on themselves, keeping as far as possible away from any mention of illness. Not Rose. "A simple blood test can tell if one is a carrier or not," she says, "and then it is easy to monitor one's health. Prevention or early detection makes treatment much, much easier – and alleviates most of the pain and suffering that I had to go through." One in forty Ashkenazi women carry the BRCA 1 or 2 gene-mutations and Dembitzer is determined to help them find out about it in time.

Together with geneticist Dr. Efrat Levi-Lahat, she initiated "Prevention GENE-ration" - a program run in conjunction with Miri Ziv, Director of the Israel Cancer Association, to raise awareness of the gene and educate women to get themselves tested and get genetic counseling. In September an initial launching in 10 hospitals throughout Israel will distribute informative brochures and posters, facilitate testing and counseling (today the waiting list for a genetic counselor can be up to a year) and provide family questionnaires that direct people towards checking for the gene if the medical history of the family suggests the gene. A pilot program with oncologists and surgeons will examine why many women don't take the test, and keep track of whether those that do get proper counseling. "It is crucial to understand the implications of being tested," Rose emphasizes. "Being a carrier is not a death sentence. Discovering that you are a carrier in time can save your life." It can also save the lives of your children; each child has a 50% chance of inheriting the gene mutation, which occurs in both men and women.

For the past few years Rose's own life has not lived up to the sweet promise of her name; it's no bed of roses to undergo what she has suffered. Yet, in her calm and elegant manner, she somehow manages to harness her experiences for the good – spreading health and happiness with the help of the Northern Charitable Foundation, a Dembitzer family trust. Sixty young girls from all over Israel are now playing competitive tennis, thanks to her. And countless women may live long and happy lives, with potential illness smashed out of them before any damage is done because of her new initiative.

May her next forty-seven years, and beyond, be trouble-free and filled with fun, with double-faulting on the tennis court being her biggest problem. And even that, only very occasionally.

For more details on the tennis program please see www.israeltenniscenters.org

For information on GENE-ration please visit http://www.cancer.org.il/ and see

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