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Jewish women should get mammograms at 40, experts say. Here’s why.
When Yaffa Leah Field was in her late 20s, she decided to undergo genetic testing.
Her grandmother had had breast cancer, and Field wanted to know whether she was among the one of every 40 Jewish women of Ashkenazi descent with either the BRCA1 or BRCA2 genetic mutations, which make them extra susceptible to breast cancer.
If she did have one of those mutations, her chances of developing breast cancer by age 70 would be roughly 50% in her lifetime, according to the Centers for Disease Control.
“The test came back negative,” said Field, now 43 and the mother of three boys.
Though temporarily relieved, she knew that breast cancer risk is not limited to those with the genetic mutations. Roughly one in eight women will develop the disease in their lifetime, and men, too, can have breast cancer.
Close monitoring, therefore, is essential. For women, that means not only regularly checking their breasts themselves for lumps or abnormalities, but getting mammograms. The question is when to start.
Field, who now works at Sharsheret, the national Jewish nonprofit that offers education, counseling and support to women facing breast and ovarian cancer, got her professional start as a physician’s assistant, so she knew how important it was to “do my screening on time.”
But what exactly “on time” means has been the subject of much debate and disagreement.
The question came to the fore again this spring when a panel of experts serving on the United States Preventive Services Task Force (USPSTF) revised earlier guidelines and changed the recommended age that women get their first mammograms to 40, from 50, and suggested that they continue to have mammograms done once every two years. It’s not the first time the recommendation has changed.
“In 2016 the US Task Force changed the guidelines from 40 to 50,” said Dr. Caryn Gamss, a radiologist at Murray Hill Radiology in Manhattan.
Gamss is also a member of Sharsheret’s Medical Advisory Board. In her practice, Gamss adheres to guidelines from the American College of Radiology that recommend starting yearly screenings at age 40 provided a person has no risk factors.
“Fifty is too late,” Gamss says.
Even waiting until age 40 can be risky, as recent studies have shown high breast cancer mortality rates for women in that age group, she noted.
“People need to think about it younger instead of waiting and then finding out ‘My mother had cancer, my grandmother…’ — and they show up at 40 and have cancer, too,” Gamss said.
Her recommendation is that all women undergo a breast cancer risk assessment by age 25. That entails answering a panel of questions that covers one’s family and medical history. Among other things, the assessment inquires whether a person had “a biopsy and a high risk lesion; breast density, if someone has lymphoma and was treated under the age of 25; if someone got upper abdominal radiation before age 25.”
The responses to these questions help doctors determine when and how individual patients should be screened — including whether to do MRIs and ultrasounds to supplement mammograms, for example. At-risk women should start their 30s armed with information and a plan.
Short of that, there is what Peggy Cottrell, Sharsheret’s genetics program manager, calls a general rule of thumb: “If breast cancer has been diagnosed at a particular age, you want to start screening 10 years before that. So if someone’s mother was diagnosed with breast cancer at 45, that person is going to start screening at 35.”
Avoiding smoking and alcohol, exercising, and a good diet are important to maintaining good health, Cottrell notes, but perhaps the biggest factor is chance. In fact, hereditary cancers like those caused by BRCA mutations account for only 15% of all breast cancers; most occur for reasons unknown. That makes screening all the more essential.
“For many women, knowing there is something they can do that can reduce their risk motivates them,” she said.
Many women delay getting mammograms out of fear of the results, nervousness about the process or just general anxiety. This is another area where Sharsheret provides women with help and guidance – even in the waiting room.
In order for doctors to interpret mammograms properly, they require two specific views of each breast. Sometimes, technicians need to take more than four photos to ensure they get those views; it doesn’t mean anything is wrong.
Women with no risk factors should get their first mammogram at age 40, experts now say, and to determine their level of risk, all women should undergo a breast cancer risk assessment by age 25. (Carol Yepes/Getty Images)
Even if you’re asked to come for a follow-up mammogram – what’s known as a diagnostic mammogram – it just means that more imaging is required, not that there’s necessarily a problem. Sometimes doctors observe a change in appearance from the prior year or a fold in the skin; other times the original image failed to capture the necessary view. Likewise, for some younger women and those with dense breasts, a mammogram may not suffice; doctors may require an ultrasound or MRI to examine the breast adequately.
Adina Fleischmann, a social worker who serves as Sharsheret’s chief services officer, recommends that each individual discuss their own circumstances with their healthcare provider. Sharsheret tries to promote awareness of the importance of getting breast cancer risk assessments, and to provide guidance to women about what to ask.
“We want to make sure that each woman who reaches out is able to ask the right questions: How often should I be screened? What’s the most appropriate screening method for me? Questions about what breast density means and how it can impact them,” Fleischmann said. “Those are the tools we want to give to our women.”
Women seeking guidance are encouraged to call Sharsheret toll-free at 866 474-2774 to connect with therapists and genetic counselors.
Sharsheret also offers peer-to-peer support, programs to guide cancer patients on how to talk about their illness with their children, and support to people who have a family member with breast cancer, including financial assistance for non-medical services critical to women’s quality of life and body image, such as acquiring wigs. Sharsheret also hosts live events such as barbecues, online yoga classes, family fun runs and other programs to empower women with cancer and foster a sense of community.
The education and awareness programming Sharsheret runs start as early as high school and college campuses, such as an annual Pink Day that includes grassroots fundraising events at hundreds of campuses worldwide.
“Sharsheret is here to arm you with education and to let you know that you’re not alone,” Fleischmann said. “Cancer screening, and the knowledge that comes along with it, can be empowering. By speaking with your healthcare provider about the screening guidelines that are most appropriate for you, you are taking a step toward your best health.”
As for Field, she went for her first baseline mammogram at age 40 — in the spring of 2020, just as Covid hit and the world masked up and locked down. The doctors identified something suspicious.
“It started a roller coaster of diagnostic testing. I wound up with eight biopsies, and in the end I had a bilateral mastectomy,” Field said after cancer was identified. “I feel thankful it was found very early.”
Her advice: Know your body and your family history.
“Breast cancer doesn’t just affect women 40 and older,” Field said. “Know your potential risks. Empower yourself to know what you need to be aware of. It shouldn’t be a shock. Be appropriately proactive.”
“And most importantly, when you reach the age when it’s recommended, get screened,” Field said. “It may be uncomfortable for a few minutes, but it’ll give you peace of mind.”
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(New York Jewish Week) — On Friday evening, several dozen people huddled underneath umbrellas and raincoats in a new sukkah in Brooklyn that had survived the day’s record-setting rainstorm.
The sukkah, created by queer textile artist Hilla Shapira, was unharmed: Its light purple walls were made of ripstop, a lightweight and water-resistant fabric. Its soft and pillowy decorations — which included Jewish symbols like hamsas as well as depictions of the four species — were made of dacron, a durable, polyester batting that held up in the deluge as well.
Shapira said the project — titled Lavender Diaspora — was meant to channel her identities as a queer person who grew up in a religious household in Israel, and also as an immigrant in the United States, where she studied art in Michigan before moving to Brooklyn.
“I try to find parallel relationships between what it is to be queer and Jewish, and to be a person from Israel,” Shapira, 33, told the New York Jewish Week. “It’s especially relevant when we’re talking about Sukkot, which is a holiday that the Jewish people were celebrating in the in-between space, between Egypt and Israel — they were on the way somewhere, but in something that is temporary and stuck in this kind of forever nomadism.”
Shapira holding one of her hamsas as she builds Lavender Diaspora in Prospect Heights. (Courtesy The Neighborhood.)
Speaking at a Shabbat dinner hosted by The Neighborhood: An Urban Center for Jewish Life, the Brooklyn-based organization that commissioned the sukkah, Shapira said she had designed her structure to celebrate communities that find themselves on the outskirts of society.
She was speaking on the first night of Sukkot, the weeklong holiday in which Jews build a temporary structure called a sukkah, meant to commemorate in part the structures that the Israelites lived in as they wandered through the desert from Egypt to Israel. Throughout the holiday, which ends at sundown on Saturday, Jews eat, pray and even sleep in the sukkah.
The Neighborhood has partnered with 12 other Jewish communities and organizations to celebrate and host events in the unique sukkah, including Romemu Brooklyn, Lab/Shul, Jews of Color Initiative and the Prospect Heights Shul.
“We were really excited to think about not just a sukkah as an art object, but really also as a place to bring different communities and groups of people together in this temporary structure,” Rebecca Guber, the founding director of The Neighborhood, told the New York Jewish Week.
“We also thought about what were some different perspectives that we could bring into this stuff,” she added. “We wanted something that brings in young families, that would be comfortable if you’re a more observant Jew and that also feels kind of wild.”
Located in the courtyard of Luria Academy, a Jewish day school in Prospect Heights, students will use the sukkah for their meals and programming during the day. In the evenings and on the weekend, The Neighborhood will use the sukkah for its own programming, which includes the launch of a Sukkot zine in partnership with Ayin Press, a family-friendly music jam, a dance event and more.
As a queer woman who grew up in an Orthodox home in Israel — as well as an immigrant to the United States — Shapira said she’s often searched for a sense of belonging. “The sukkah I tried to create is a space that is offering an alternative, or making a suggestion for a communal space for all the ‘shoulders’ of society,” she said.
Lavender, the color of the walls of the sukkah, is a symbol of LGBTQ resistance and activism. The other half of the title, Diaspora, refers to both the dispersion of the Jewish people as well as the feeling of marginalization experienced by Jews, LBGTQ people and other minorities — the sukkah is meant to be a temporary space that alleviates that feeling.
The Neighborhood is a community hub that primarily partners with other Jewish organizations to create innovative Jewish cultural and spiritual events for Jewish life. The Lavender Diaspora sukkah was funded by UJA-Federation New York. (UJA-Federation is also a funder of 70 Faces Media, the parent company of the New York Jewish Week.)
“What really resonates for us is the way that this sukkah welcomes everyone in — whatever position you feel you occupy in the Jewish community — maybe some people feel like insiders, other feel like outsiders, we really hope this can be a place where many different people can feel welcomed, and that their perspectives and identities are being honored,” Guber said.
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(JTA) — The temporary shelters that Jews erect during the holiday of Sukkot are meant in part to recall a time when Jews had nowhere permanent to live. In Northeast India, that symbolism is heavy with additional meaning this year.
That’s because large numbers of Bnei Menashe, the Jewish community that lives there, have fled their homes in the state of Manipur since ethnic unrest broke out in early May.
According to the Israeli organization Shavei Israel, about 2,000 people from the Jewish community have been displaced. A different nonprofit that works with the community, Degel Menashe, cites a smaller number, 700.
But either way, the community has been ravaged, with three locations that have been home to large numbers of Bnei Menashe decimated in the violence. Synagogues and homes have burned to the ground, and the number of displaced people has only grown with time.
Now, as the conflict enters its sixth month, what many believed would be temporary displacements in the Manipur hills or the neighboring state of Mizoram are becoming permanent.
“Despite these challenging times for the Bnei Menashe and even in the farthest reaches of northeastern India, they have continued to uphold the ancient tradition of building Sukkot in honor of the festival,” said Michael Freund, chairman and founder of Shavei Israel, which helps “lost tribe” communities return to Israel.
Shavei Israel distributed pictures showing members of the community constructing sukkahs out of bamboo. Their efforts come as their own safety in their areas where they live is in question — or already compromised.
“[For] the Bnei Menashe and the rest of the people who have left Imphal, I don’t think there is any chance of them returning back because there is no security,” said Isaac Thangjom, the Israel-based director of Degel Menashe, which assists Bnei Menashe communities in Israel and India, referring to Manipur’s capital city. “If you ask me honestly, the separation is complete.”
The Bnei Menashe identify as descendants of a “lost tribe” group, tracing their origins to the Israelite tribe of Menasseh. In 2005, a chief rabbi of Israel affirmed their identity as a “lost tribe” group with historic Jewish ties, but researchers have not found sufficient evidence to back the claim. Bnei Menashe Jews began immigrating to Israel in the 1990s, and because of their “lost tribe” status, they all undergo formal Orthodox conversions upon arrival. Around 5,000 remain in the states of Manipur and Mizoram today, and about 5,000 have already immigrated to Israel.
Many have struggled to gain entry into Israel over the past two decades, and they are now asking the Jewish state to expedite the immigration process to help them escape the violence.
Israeli authorities have yet to comment publicly about the situation and did not respond to multiple requests for comment from the Jewish Telegraphic Agency. Israel has recently been seeking to advance its relations with India.
Conflict erupted in May when tribal groups in Manipur launched a protest against the ethnic majority Meitei’s demand for Scheduled Tribe status, which is traditionally reserved for minority tribes. The Bnei Menashe Jews belong to the minority Kuki tribe.
The Kukis (about 16% of the population and majority Christian) say the Meiteis (53% and majority Hindu) already have outsized privilege and political representation in Manipur.
A destroyed house is seen seen in the northeastern Indian state of Manipur following the clashes between Meiteis and Kukis, Aug. 11, 2023. (Biplov Bhuyan/SOPA Images/LightRocket via Getty Images)
According to local reports, unofficial “but very real” borders have been drawn between what have become Kuki and Meitei areas. Prime Minister Narendra Modi’s government has been criticized for failing to control the situation. In August, opposition lawmakers called for a no-confidence vote over Modi’s handling of the situation, but it was easily defeated.
Some 190 people have died in the conflict since May, according to local media, including at least one Bnei Menashe community member. Over 60,000 are displaced.
Several other Bnei Menashe Jews are hospitalized with injuries, according to Shavei Israel.
In the face of displacement, the Bnei Menashe Jews have remained religiously observant, even as some fled with nothing more than their prayer books and the clothes on their backs, a Mizoram Jewish community member told JTA in June.
“It was so sudden,” said Ariella Haokip, a Bnei Menashe community member taking shelter in Thingdawl, Mizoram. “Funds were sent to us to buy special items for Rosh Hashanah and now for Sukkot. In spite of our misery, it is comforting to think that we are remembered.”
Some are currently staying at government shelters, others at schools and homes of other community members, or rented homes paid for by nonprofit groups. In Thingdawl, Mizoram, one young member has begun organizing Hebrew classes for displaced members, said Thangjom.
Members of India’s Bnei Menashe community pose outside a structure under construction as a semi-permanent dwelling for nine families displaced by ethnic violence in the Manipur region of India. (Courtesy Degel Menashe)
Both Shavei Israel and Degel Menashe have been working since May to provide continued support to the Bnei Menashe Jews through donations of food, mattresses, mosquito nets, infant formula, medicines and other necessities. Both organizations have arranged shelters for displaced families. Additional financial support has poured in from Jewish and Christian organizations in the United States and Israel.
For some, the High Holiday season also represents a new beginning, as Degel Menashe races to construct homes for several Bnei Menashe families. Lalam Hangshing, chairman of the Bnei Menashe Council-India, donated a piece of land of about 200 acres in Churachandpur on which nine homes are being constructed.
“It was hoped that it could be ready by Rosh Hashanah but there were some unforeseen delays and challenges,” said Thangjom. “Each family will be allotted a piece of land to grow or raise something of their choice so that it can be a source of livelihood for them.”
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(JTA) — I first met Alice Shalvi, the mother of religious feminism in Israel, in the mid-1990s during a meeting of ICAR, the International Coalition of Agunah Rights, a coalition that she founded to advocate for women denied a religious divorce by their husbands. She was in her early 70s at the time, and had been fighting for agunah rights for 20 years.
I was in my mid-20s, and new to the cause. I was there as co-chair of Mavoi Satum, which a group of us founded in 1995. This coalition was meant to be advancing systemic solutions to this awful problem. But, of course, we were stuck. As stuck then as we are now.
At one point in the meeting, Professor Shalvi started to cry. “I am 72 years old. I have been talking about this for so long,” she said, “and nothing is changing.” She was crying because the suffering of women didn’t seem to matter to our people. Then she turned to me and said, “It’s up to you and your generation to fix this.”
At the time, I felt her passing the mantle, and I didn’t want to let her down. But I’m sure I did. At least on this front. On others, too, despite our best efforts.
Shalvi, who died Monday morning in Israel at age 96, fought crucial fights decades before the rest of the world caught up with her, before the religious community had any kind of language for what she was doing, before there was any kind of feminist movement to speak of in Israel.
She pioneered feminist ideas in Israel in the early 1970s when there were only a handful of women doing such work — Marcia Freedman, Naomi Chazan and a few others. And she was the only one coming from the religious world, and able to see the need and potential for change before everyone else.
Starting in 1975, Shalvi began running the Pelech School for Haredi Girls, a religious feminist school, before Orthodox feminism existed as a movement — before Women of the Wall, before women’s tefillah (prayer) groups, years before Jewish Orthodox Feminist Alliance and Kolech, Israel’s Religious Women’s Forum, existed, before anyone even dared to put the words “feminist” and “religious” together in a sentence. Before even the Conservative movement had women rabbis. Everyone else is still catching up.
She also worked in the non-religious arena, creating, in 1984, the first feminist lobby in Israel, the Israel Women’s Network, which still pioneers on many fronts.
She also dared to work on issues of peace, taking positions that were considered pas nisht, or “unsuitable,” in the religious world — and for the most part still are. She dared to see Palestinians, especially Palestinian women, as equal human beings. This was not a position that religious Israelis, or Israelis in general, were comfortable with. It’s still an uphill battle. She spoke and acted from a place of humanity first.
And she could remarkably work on a multitude of fronts, all at once, including education, academia, advocacy, politics and peace.
Alice Hildegard Shalvi was born in Essen, Germany, on Oct. 16, 1926. She, her mother and brother joined their father in London in 1934, and she later earned degrees in literature and social work. She immigrated to Israel in 1949, taught at Hebrew University and led efforts to create an English department at Ben-Gurion University. Denied the deanship because she was a woman, she mobilized female faculty members in protest.
Orthodox feminist activist Alice Shalvi, right and author Elana Sztokman in 2017, attending the ordination ceremony for Israeli rabbis at the Hebrew Union College-Jewish Institute of Religion in Jerusalem. (Courtesy Elana Sztokman)
Professor Shalvi was my formal mentor when I was on the Jerusalem Fellows, a program in Jewish education. We would meet regularly and talk about feminism, politics, religion and Israel. It was a privilege to spend those hours in one-on-one conversations. Prof. Shalvi always talked to me with complete honesty, passion and belief in what she was working for. She entrusted me with her vision, and made me feel like she believed that I would hold it for her and continue to birth it in the world.
By the time changes started to take place in Orthodoxy for women — evidenced by Shira Hadasha, a Jerusalem congregation dedicated to halachah (Jewish law) and feminism, and Orthodox women in clergy roles — she had already moved on to the Conservative movement, serving as rector of what is now the Schechter Institute of Jewish Studies, a graduate school and seminary associated with the movement’s Jewish Theological Seminary. She needed to go where her vision was valued and welcomed and celebrated, instead of where everything was a fight. She was highly criticized for that decision and was treated by some as a sort of traitor to the Orthodox feminist cause. But she deserved to be in a place that supported her and brought her comfort and respect, and she had earned that right.
She offered words of support for me when I took a similar leap and enrolled in Reform rabbinical school. Even though I am no longer in rabbinical school and do not associate with the Reform movement in any meaningful way, I do not regret the decision to step away from an Orthodox version of feminism and try on other hats. She inspired me and so many others to take leaps, be courageous, live from the heart and ignore the haters.
I am so glad that she found her well-deserved place in the world, and that she received many well-deserved honors and accolades along the way, including, in 1991, the Ministry of Education’s Education Prize in 1991 for teaching Talmud to girls and insisting that Pelech alumnae serve in either the IDF or the National Service. In 2007, she won the Israel Prize for her life’s work, and in 2019 a National Jewish Book Award for her memoir, “Never a Native.”
She left an incredible legacy of activism that has birthed generations of change agents in Israel.
I have often thought over the years that I wanted to be Alice Shalvi when I grew up. I loved her unstoppable courage, her ability to wear many hats, her resilience in standing up to the haters and naysayers, and her constant belief that she could make a difference. I’ve tried to follow that kind of path, though I have not had nearly the kind of strength and fortitude — and successes — that she had. But her personality and vision continue to have a permanent resting place in my heart. And I will continue to endeavor to carry her torch in this world.
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