Are you a Sephardi or Mizrahi Jew? Your risk for breast cancer may be greater than you think.

Michelle is a 43-year-old teacher who lives in Great Neck, New York. Like many women in her close-knit Persian Jewish community, she didn’t think seriously about breast cancer. 

That changed just over a year ago. That’s when doctors found something suspicious after her annual mammogram and asked her to come back for a sonogram — then a biopsy, and finally an MRI. 

“On July 2, 2025, I got the definitive diagnosis: triple-positive breast cancer. It was a lot to take in,” said Michelle, a mother of four children ranging in age from 8 to 17, who didn’t want to use her real name for privacy reasons. “My oldest son was on a trip abroad with his friends, so I waited to share the news until he was back. I told them I was going through chemo, but obviously kept most of the medical details to myself. They handled it very well.”

Michelle was aware that Jewish women of Ashkenazi, or Eastern European, origin were far more likely to inherit BRCA1 or BRCA2 mutations than the general population. But she had no idea that women of Sephardic or Middle Eastern origin were also at elevated risk for these mutations, which increase the risk of certain cancers, including breast and ovarian cancer.

Statistics show that among the general population, 1 in 400 women carry the BRCA mutations. Among Ashkenazi Jews, however, the probability of carrying this mutation is 10 times higher, occurring in 1 out of 40 individuals. When it comes to Sephardic Jews — descendants of Jews who hail from the Iberian Peninsula — the risk is 1 in 140. 

“I’m the first woman in my family to be diagnosed with the disease,” said Michelle, who, like most individuals with breast cancer, is not a carrier of the BRCA mutation. “Nobody in my immediate circle has ever had it, and I didn’t know why genetic testing would apply to me.” Michelle had to do six rounds of chemotherapy to shrink her tumor, which was more than two centimeters long. And then she underwent a double mastectomy.

So did bestselling cookbook author Kim Kushner of New York City, who at the age of 40 was surprised to learn that she carried the BRCA2 mutation.

“As a Canadian-born Moroccan Jew, I — like many people — associated these risks more with the Ashkenazi community, so my diagnosis was an important reminder that hereditary cancer can affect Jewish families of all backgrounds,” Kushner said. “My journey reinforced the importance of genetic testing, family history and being proactive about our health.”

Kushner is on the board of Sharsheret, a nonprofit organization that advocates for Jewish breast, ovarian and endometrial cancer patients — and their families — in the United States and Israel. 

“Through my work with Sharsheret, an incredible organization that provides invaluable resources, support and education, I hope to help raise awareness, encourage conversations and empower others to make informed decisions for themselves and their families,” she said.

Bita Nehoray is a genetic counselor at City of Hope National Medical Center in Los Angeles, where for the past 14 years she’s focused on those with a personal or family history of cancer. “There are a lot more data and medical literature related to well-known mutations in people of Ashkenazi descent, but founder variants are also found in those of Sephardi and Mizrahi backgrounds,” she said. “A lot of that has to do with history, and how Jews have had to disperse over time.”

Peggy Cottrell, a genetic counselor with Sharsheret — whose name is Hebrew for “chain” — said that while the risk for Sephardi Jews isn’t as high as for Ashkenazim, it’s important to remember it is much higher than for non-Jews.

“These are very old mutations and tend to be seen among all Jews,” Cottrell said. “People think of BRCA as only being an Ashkenazi thing, and that’s not the case. That’s why anybody who has a family history of breast cancer, male breast, ovarian, pancreatic, melanoma or prostate cancer needs to be very careful and get a screening test.”

Sharsheret CEO Elana Silber said it’s critical to educate Jews today — regardless of their ethnic origin — about their relative risk of developing breast cancer and other cancers.

“Understanding family history, recognizing risk and having informed conversations about screening and genetics saves lives,” she said. “With reliable information in hand, we can prevent cancer or diagnose it in earlier stages.”

“The Sephardi Jewish community is genetically diverse, and not all Sephardi populations necessarily have the same risk of carrying a BRCA mutation,” said Dr. Sharon Grossman, an Israel-based radiation oncologist and public health specialist.

Among Ashkenazi Jews, three common BRCA mutations account for most such mutations, she said, meaning that a targeted test looking for those three can identify most carriers. 

Non-Ashkenazi Jews, however, come from many different communities — including Afghanistan, the Iberian Peninsula, Iran, Iraq, North Africa and Yemen — and each has its own genetic history. 

“Researchers have identified different founder mutations — those passed down within a particular population — in several of these groups, while other mutations may be rare or limited to a single family,” said Dr. Grossman, who is a member of Sharsheret in Israel’s Medical Advisory Board. “As a result, there is no single, standard panel that captures most BRCA mutations across non-Ashkenazi Jewish populations.”

Nehoray said that specifically in the case of Persian Jews like Michelle, it makes more sense to do comprehensive genetic testing “where we’re doing comprehensive analysis of these genes of interest,” rather than focusing on unique founder variants. 

Fortunately, she added, comprehensive panels can now be done for a few hundred dollars, making them much more affordable than in the past.

Another challenge that many Mizrahi and Sephardi Jews face: There’s not a lot of data about these communities, partly because they are often underrepresented in clinical trials.

“For example, in the U.S., the focus for race/ethnicity categories is often whether or not someone is Ashkenazi Jewish, and then separately one’s self-reported race category, with limited options to choose from. So there aren’t even necessarily discrete data variables for studies that will help distinguish JIMENA,” Nehoray said, using an acronym for Jews Indigenous to the Middle East and North Africa. 

“Other considerations are to look to researchers in Israel who are going to be more attuned to the subethnic and multiethnic Jewish populations to recognize these distinctions,” she added.

Despite the advances in screening for BRCA, barriers do remain — studies from the U.S. demonstrate that this is especially true for Orthodox Jewish women.

“One stigma is that it’ll interfere with shidduchim [arranged marriages]. Another is this tremendous, overwhelming fear of cancer,” Dr. Grossman said. “There is a notion among some members of the Orthodox community that even saying the word ‘cancer’ can bring the disease.”

Such perceptions could be an impediment to genetic testing — which is why it’s so important for organizations like Sharsheret to educate religious women about what it means to carry these mutations.

“Just because you’re not Ashkenazi doesn’t mean you don’t have a risk of carrying a BRCA mutation,” Dr. Grossman said. “People with a significant personal or family history of cancer should think about meeting with a genetic counselor and seeing if it makes sense to test.”

She added: “We also need to destigmatize cancer so that women and men will pursue genetic testing and learn about steps they can take to save their lives.”

Talk to your healthcare provider about your family history and connect with Sharsheret genetic counselors at genetics@sharsheret.org to learn more about hereditary cancer risk.