Mizrahi women at higher risk for cervical cancer

Jewish Israeli women of North African origin are at higher risk for cervical cancer than other Israeli women, a recent study shows. Researchers at the Health Ministry and the Gertner Institute for Epidemiology and Health Policy Research studied 938 Israeli women with malignant cervical tumors from 2000-2005 and found a higher cancer rate among women of North African origin.

The findings, published in the International Journal of Gynecological Cancer, is in line with statistics showing that the rate of cervical cancer in Israel is lower than in other Western countries.

Five of every 100,000 Israeli women develop cervical cancer, but Mizrahi women – Jews of Middle Eastern or North African descent – show a far higher incidence rate than their Ashkenazi peers. The study indicated that among Israeli Jewish women born in North Africa the rate of cervical cancer is 15 per 100,000 – three times the Israeli average overall.

The gap between Mizrahi and Ashkenazi women begins to grow when the women reach their 30s and peaks between the ages of 55 and 59 and again over the age of 75.

The study indicated that North African-born Israeli women are 35 percent more likely than other Israeli women to develop cervical cancer – 2.2 times more likely than those born in Asia and 1.7 times higher than those born in Europe and North America.

An Israeli study conducted 20 years ago found higher cervical cancer rates among Moroccan-born Israeli women in comparison to native-born Israelis. The current study, however, found that even second-generation Israelis of North African origin show a higher incidence of cervical cancer than the national average.

Researchers believe the higher figures point to a genetic predisposition of Mizrahi women to develop cancerous cervical growths, growths caused by the papillomavirus. By contrast, Ashkenazi women are more likely to develop breast cancer.

International studies have already found evidence for the genetic mutation leading to cervical cancer on the p53 gene.

“While the incidence of precancerous cervical morbidity in Israel is similar to those in other Western countries, the development of rare cancers is lower in Israel, leading to the conclusion that most women in Israel are protected from the development of [most] cancers. It is, however, possible that this protection is weaker among women of North African origin,” said Dr. Siegal Sadetzki, director of the unit for cancer epidemiology at the Gertner Institute.

Extra precautions

The findings also have implications for immunization technology. According to Sadetzki, “An at-risk population must take extra precautions. The current study indicates that it is possible that a North African background is a marker for membership in a population at risk of developing cancerous growths, but additional studies must be carried out to determine all of the disease’s risk factors.”

“In Israel there is only limited information on cervical cancer, a serious situation given the need to address the matter today, when there is a vaccine for the disease and the possibility of early detection,” she said, in reference to the human papillomavirus vaccine which protects patients from two strains of the cancer-causing virus.

The Health Ministry has set 2011 as the deadline for including the HPV vaccine in the national vaccine program. Meanwhile, a debate is raging within the ministry between researchers and physicians over the need to allocate funds for including the vaccine in Israel’s subsidized basket of health services, given the country’s relatively low incidence rate.

“According to the old guidelines, populations were considered at risk for cervical cancer if they had had at least three sexual partners. Today this characterization is both ridiculous and archaic, and it’s important to define the relevant risk factors for developing the disease in 2009,” Sadetzki said.

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