Hereditary cancers aren’t just a women’s problem. Jewish men need to take precautions too.
Bill Harris, a veteran Los Angeles photojournalist, didn’t think much of it when one morning in 2012 he woke up and found a tiny blood spot on the T-shirt he’d slept in. The next morning, he found blood in the same place on his chest — and went straight to his computer.
“Online, I could find only three things that would cause a man’s nipple to discharge blood: being an avid runner, which I wasn’t; having a subtropical fungus, which I didn’t; and breast cancer,” he said. “That was a pretty big shock.”
Harris, then just a few weeks shy of his 61st birthday, immediately called his doctor, who ordered a mammogram and ultrasound. They confirmed a cancerous growth in his right breast. Ten days later, a biopsy came back positive. The next month Harris got a right mastectomy, followed by the removal of his left breast half a year later.
“I walked into a woman’s imaging center and had to get into a pink paper robe,” he recalled. “All the women in the waiting room were staring at me.”
Like many other Ashkenazi men, Harris never had considered that he might have been born with a harmful mutation of the BRCA gene, which elevates the risk not only of breast cancer, but also of melanoma and prostate, ovarian and pancreatic cancer.
“Hundreds of other mutations in the BRCA gene are just as dangerous, but they’re not specific to Ashkenazim,” said Dr. Robert Sidlow, director of the Male BRCA Genetic Risk Program at New York’s Memorial Sloan Kettering Cancer Center. About 1 in 40 Ashkenazi Jews (those of Eastern European descent) carries the harmful mutation, compared to about 1 in 400 in the general population.
“The vast majority of patients I see are relatives of women who have breast or ovarian cancer and then get tested,” he said. Of BRCA mutation carriers, Sidlow added, “Most men are pretty happy to enroll in some kind of surveillance program once they get over the initial shock.”
Sidlow is on the Men’s Leadership Council at Sharsheret, the national Jewish nonprofit organization that educates the community about cancer risks and supports those with breast cancer and ovarian cancer.
Elana Silber, CEO of Sharsheret (Hebrew for “chain”), says it’s crucial that men with a family history of cancer undergo genetic counseling screening for BRCA and other hereditary cancer mutations.
Genetic testing is possible via a standard blood or saliva sample.
While Sharsheret is primarily considered a women’s organization, it has been using November — nicknamed Movember for its focus on men’s health — for an awareness campaign focused on Jewish men’s cancer risks.
“This is not only a women’s issue,” Silber said. “Family history is so important. When a man shares his family history with his doctor, he may not realize that he should mention that his mother had breast cancer or that his sister had ovarian cancer, as these are not generally ‘men’s diseases.’ They are not aware that these cancers could mean that they themselves are at increased risk for cancer and that they can pass on these mutations to the next generation – their daughters and their sons.”
If someone discovers he (or she) is a carrier of one of the genetic mutations with elevated cancer risks — not just BRCA but also such mutations as ATM, TP53, CHEK2, and PALB2 — there are various precautions they can take for themselves and their children. They can monitor their own health more closely, they can get encourage their children to test to see if they are carriers and, for any future children, take steps to prevent the mutated genes from being passed down.
For example, couples can conceive via in vitro fertilization, or IVF, and then test the embryos before implantation to ensure that only those unaffected by the genetic mutation are implanted.
While most women are aware of the risks of breast cancer, men generally are not — even though the disease strikes 2,500 men in the U.S. every year and kills about 500 of them, according to Sidlow. About 1-2% of men with the BRCA1 mutation and 6-7% of men with the BRCA2 mutation will develop cancer by age 80.
“This is why we recommend periodic mammograms starting at about age 50 for men who carry a BRCA2 mutation,” Sidlow said. “We like to educate these men on how to check their chests once a month and have a clinician do a breast checkup on them once a year.”
Since the BRCA1 and BRCA2 mutations also make prostate cancer more likely, men with either mutation should get PSA (prostate-specific antigen) levels in their blood tested annually beginning at age 40, rather than 50, the age at which screening generally begins, Sidlow said.
Sharsheret has been promoting the importance of learning one’s family history, genetic counseling and screening among both men and women. The 20-year-old organization also runs various peer support networks, offers financial assistance to cancer patients, provides mental health counseling and guidance to patients, caregivers, and their friends, and seeks to educate the broader Jewish community about cancer risks and support.
Peggy Cottrell, a certified genetic counselor at Sharsheret, said men in general are more reluctant to get regular checkups than women.
Ashkenazi Jewish men are at elevated risk not just of breast and prostate cancer but also of pancreatic cancer. Pancreatic cancer is particularly difficult because it’s tough to detect early enough and hard to treat. The five-year survival rate is only 11%. About 2% of BRCA1 carriers and 4% of BRCA2 carriers will develop pancreatic cancer, Sidlow estimated.
“Usually by the time pancreas cancer is clinically detected it has already spread microscopically to the liver,” Sidlow said. “But pancreas cancer is potentially curable if caught when the tumor is extremely small.”
Even among those with elevated risks, certain behaviors can improve one’s odds, such as avoiding obesity, smoking and excessive alcohol consumption.
Harris, the California photojournalist, is still fighting at age 71. While he overcame breast cancer 10 years ago, last year he was diagnosed with ampullary cancer, a rare disease related to his BRCA2 status that was discovered thanks to his participation in a UCLA study. Surgeons have removed his gall bladder, half his pancreas and part of his small intestine, and he has had to endure eight rounds of chemotherapy.
“I’m still working through the aftereffects of the chemo. I have to eat smaller quantities than before and take enzymes to supplement my digestive processes,” Harris said.
Meanwhile, his 37-year-old son discovered that he, too, carries the BRCA2 mutation, and he had a double prophylactic mastectomy and reconstruction at age 30 — just to be on the safe side.
“If there’s any history of breast, ovarian or prostate cancer in your family, get tested genetically so that you’re informed,” Harris advised. “Diagnoses happen way too late for men, and the danger is too big.”
A little‑remembered Gilded Age millionaire helped make milk safe for American kids through his ‘retail giving’
The 1844 edition of the widely used schoolbook written by William H. McGuffey, “Newly Revised Eclectic Fourth Reader,” includes a dialogue about the difference between “true and false philanthropy”:
Mr. Fantom: I despise a narrow field. O for the reign of universal benevolence! I want to make all mankind good and happy.
Mr. Goodman: Dear me! Sure, that must be a wholesale sort of a job: had you not better try your hand at a town or neighborhood first?
As the discussion continues, the lesson becomes clear. Mr. Fantom’s approach is too ambitious to accomplish much, while Mr. Goodman’s, if narrower in scope, was likely to be more useful in practice.
Nathan Straus made his mark in philanthropy after a successful career running the Macy’s department store. Library of Congress Image by
Many of Straus’ contemporary philanthropists were setting lofty goals for their giving. In oil magnate John D. Rockefeller’s case, it was promoting “the welfare of humanity throughout the world.” For steel tycoon Andrew Carnegie, it was “to promote the advancement and diffusion of knowledge and understanding.”
Straus pursued more mundane objectives that included championing milk pasteurization. Although his efforts are not as well known today as those of his more ambitious – and wealthier – counterparts, they accomplished a lot and showed that what might be called “retail giving” can have far-reaching effects.
Successful immigration story
The Straus family came to the United States from Germany in the 1850s during the first big wave of Jewish immigration. Lazarus Straus, Nathan’s father, followed a familiar path for Jewish immigrants at the time, beginning as a peddler and eventually establishing his own store in the small town of Talbotton, Georgia, where the members of his family were the only Jews.
He prospered, became a respected citizen and saw that his children received good educations, including in their religion.
Then the Civil War upended the family’s life, first by reviving antisemitic prejudices and then, eventually, by destroying the family’s business.
Starting anew in New York City, Lazarus and his older sons, Isidor and Nathan, began to sell imported china, glassware and other crockery to retailers in the Northeast and South. One was Rowland H. Macy, who had founded an eponymous store that was on the cutting edge of what Fisher calls a “retailing revolution.”
Macy’s innovations included stocking large inventories of many kinds of merchandise, competitive pricing, extensive advertising and providing a variety of services like public restrooms and a cafeteria to make shoppers’ experiences more pleasurable.
Aided by the rapid urban and economic growth of the late 19th century, the model flourished. Department stores displaced smaller, specialty shops. Other retail powerhouses, such as Bloomingdale’s and Lord & Taylor, soon competed with Macy’s.
The Straus family sold their wares at Macy’s. After Rowland H. Macy died, the Straus family became partners with its new owners. By 1896, the Strauses owned the store outright. And Macy’s was expanding: It bought another department store in Brooklyn and created a flagship building on Manhattan’s Herald Square, which Macy’s still occupies.
The landmark Macy’s department store in New York’s Herald Square opened in 1902 while Nathan and Isidor Straus ran the retailer. Library of Congress Image by
His philanthropy journey begins
While Isidor Straus oversaw the store’s internal operations, Nathan focused on the company’s external activities, such as purchasing, marketing and dealing with government and business leaders.
A third brother, Oscar, pursued a career as a politician and diplomat, eventually becoming secretary of commerce and labor under President Theodore Roosevelt and the first Jewish member of a presidential cabinet. Perhaps inevitably, this led to a series of public appointments for Nathan Straus.
However, as they became wealthier, Nathan and his wife, Lina, increasingly devoted their attention to a series of philanthropic projects.
In 1893, the U.S. entered a four-year economic depression, its worst until the 1930s. As unemployment in New York City rose, Nathan Straus used his merchandising skills to address the needs of the jobless and poor.
He created a number of “depots” near tenements and boarding houses that sold coal, food and fuel at discount prices. Fisher, Straus’ biographer, rightly calls these early examples of what is now known as “social entrepreneurship”: the application of business principles to solving social problems.
Making milk less deadly
As these efforts were getting away, Straus also launched what would become his major preoccupation: promoting pasteurized milk.
In New York City in the early 1890s, Fisher writes, “the annual mortality rate among children under five was about 15 percent,” or 18,000 infants and toddlers per year. A main cause was consuming raw milk, which, unless certified by inspectors, was likely not only to contain a variety of pathogens, such as tuberculosis bacteria, but spoil easily going from farm to table.
Although scientists had long known that heating could make milk safer, doctors and public health officials worried that sterilizing milk might also destroy its valuable nutrients.
Straus, who had lost one of his own children to what he believed was a milk-borne infection, built on his projects for the unemployed by working with New York social service agencies to develop pasteurization plants and infant-milk stations near low-income neighborhoods.
They sold sterilized and refrigerated milk at below-wholesale prices, or donated it to those who could not afford to pay. Businesslike efficiency kept costs low, as did donations. Multilingual ads publicized the product’s availability, doctors and nurses advised parents on child-rearing, and careful recordkeeping aimed at assessing the program’s health benefits.
Straus and his wife devoted much of their time and money to this work. In addition to establishing 297 milk stations in 36 cities, they also spoke and wrote widely about the merits of pasteurization.
By 1908, their efforts paid off when the U.S. Public Health Service endorsed pasteurization and state and local governments began requiring that milk sold in their jurisdictions be pasteurized. Raw milk remained available in many states, and debates over its safety continue to this day.
As a result of this and other Progressive Era measures, New York City’s health commissioner estimated that infant deaths dropped by two-thirds
during the first two decades of the 20th century, with similar declines elsewhere in the country.
The coastal Israeli city of Netanya was named after philanthropist Nathan Straus. Jack Guez/AFP via Getty Images Image by
Other causes
While most of Nathan Straus’ efforts occurred in the U.S., he used his trips to Europe for Macy’s to promote pasteurization on the continent.
During a 1904 visit, he toured the Mediterranean and stopped in Palestine, then part of the Ottoman Empire. Impressed by the early Jewish settlements and holy sites he saw, Straus became an ardent advocate for creating a Jewish homeland in the Middle East, an unusual position for a Jewish businessman of that era, according to Fisher.
On a subsequent trip, a broken leg kept Straus from returning to New York on the maiden voyage of the Titanic; his brother Isidor and sister-in-law Ida were not so fortunate.
In the U.S., Nathan Straus led Zionist organizations, while in Palestine, his chief contributions involved supporting a variety of health care and economic development activities, including Hadassah, the women’s health and community development organization founded by Henrietta Szold.
Nathan Straus’ achievements as a philanthropist are not widely known today because he did not create a grantmaking foundation that outlasted him, as Rockefeller and Carnegie did.
Instead, by the time of his death in 1931, Straus had donated much of his fortune. Fisher writes that Straus used to invoke an old Hebrew proverb: “Money given in health is gold. Money given in sickness is silver. Money given after death is lead.”
He also didn’t donate heavily to the burgeoning network of communal organizations set up to assist the growing population of Jewish immigrants, as did the financiers Jacob Schiff and Felix Warburg, who were also affluent Jewish immigrants from Germany.
As Fisher notes, this pattern of philanthropy resembles that of Straus’ friend – and pallbearer – Julius Rosenwald, the longtime head of Sears, Roebuck and Co. Both supported Jewish causes as well as major initiatives aimed at helping others: In Rosenwald’s case, it was schools for African American children in the South, while for Straus, it was milk pasteurization in New York City and beyond.
During and after World War I, they worked together to assist Jewish refugees in Europe. Fisher might have added that neither Straus nor Rosenwald sought much recognition for their work.
His thorough account should help give Straus the credit he deserves for his philanthropy. It should also show that donors do not have to aspire to “make all mankind good and happy” to make an important difference.
In many ways, Nathan Straus was an old-fashioned do-gooder, responding to the needs he saw with innovative solutions. As a result, he wound up accomplishing a lot of good.
“Emma,” a young Jewish woman who we met in 2019, didn’t belong to a synagogue. She didn’t have a Jewish partner. She didn’t observe Jewish rituals regularly. On most surveys about religion, she would not seem very engaged with Judaism.
But as Emma talked about what she did in her free time, a very different picture began to emerge. She visited Jewish websites and enjoyed listening to Jewish music. She read books about Jewish topics and had recently attended a retreat for young Jewish adults to learn Torah while also doing yoga.
She was highly invested in learning about Judaism, but she explored her identity without joining traditional institutions.
Most major surveys about religion ask whether someone belongs to a congregation, how often they attend services, whether they pray regularly and whether belief is important in their lives. Those measures help identify broad shifts, like the growing percentage of Americans who are religiously unaffiliated: the “nones.”
But many Americans’ religious lives, like Emma’s, are not disappearing; they are moving away from membership of traditional institutions. To understand what religion looks like in 21st-century America, researchers may need to ask different questions.
Learning through art
As scholars of Judaismand education, we have been exploring how people learn about religion beyond traditional places like synagogues, Jewish schools and summer camps. Between 2019 and early 2023, we spoke with hundreds of people and explored different leisure time activities to discover what people learn about Judaism and Jewishness through cultural arts.
We interviewed dozens of audience members at Jewish-themed shows on Broadway, such as “Leopoldstadt”and “Parade.” We attended Jewish concerts and asked attendees what they learned. We explored how social media communities offer spaces to talk about different Jewish topics, like what fans learned about ultra-Orthodox Judaism from watching the television show “Shtisel.”
‘Shtisel,’ an Israeli series about an ultra-Orthodox family in Jerusalem, ran for three seasons.
Our research revealed that there is a vibrant ecosystem of people learning about religion in their leisure time. Through the arts, both Jews and non-Jews encounter Jewish history, Jewish religious practices and representations of Jewish communities.
Screen and stage
Most people we spoke with told us that they felt meaningful connections to Judaism during activities that would rarely appear on a standard religion survey.
“Joan,” an unmarried woman in her 50s from Connecticut, told us that she was deeply invested in Judaism, but felt that synagogues and Jewish community centers were not welcoming to single people without families. Instead of joining a Jewish institution, she watched Jewish-themed TV shows and movies on Netflix, and joined social media communities to chat with other fans.
“Luis,” who lived in Boston but was born in Argentina, was a Sephardic Jew, a group that traces their ancestry and traditions to Jewish communities who once lived in Spain and Portugal. His wife was Ashkenazi, meaning her ancestors came from Central and Eastern Europe. She considered herself secular, and so the couple joined the Worker’s Circle, a nonreligious Ashkenazi institution rather than a synagogue.
Yet Luis loved deepening his knowledge of Sephardic culture, and he often attended concerts of music in Ladino, a Sephardic language related to Spanish, with other Sephardic immigrants.
American singer Sarah Aroeste writes and performs in Ladino.
For Joan and Luis, these activities were not peripheral to their Jewish lives. Rather, they were central avenues for learning and community. We interviewed hundreds of Jews who told us that cultural experiences were opportunities to reflect on Jewish practices, explore questions of belonging, connect with family histories and find friends with common interests.
New questions
Some aspects of these patterns were distinctive to Judaism. Historically, many Jews have understood Judaism to be a cultural world, and not only a theological tradition. Learning about cultural dimensions of Judaism has long been part of Jewish education.
The broader phenomenon of informal learning, though, extended far beyond a single tradition. Across America, increasing numbers of people learn about religion through media, cultural productions and digital networks. Christians may study biblical themes through podcasts, online discussion groups or religious influencers. Muslims may participate in online learning communities that connect believers across the world.
The challenge for religion researchers, then, is not simply to determine whether engagement with religion is rising or falling. Rather, it is to develop more nuanced ways of understanding how people explore religious themes and practices, beyond traditional institutions. Only then can we more fully understand how contemporary Americans actually live their religious lives.
